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HomeMy WebLinkAbout97-05491 ~ .e :1 ~. .... ~ ~ "~ ~ a q ':t " .Q :I -t::: '1 ~~ '" ~ 'd ~ - ..r -4- .. { .., ~ / , I ,/ - . - :l "- - 0- ::r In QJ F:LICr)'CFACE OF Ti" ; ;("/ 'u .oTA1Y 9~L~r~ 29 Mi 9: 09 C~,!nl:;~t i ~ 'r, ""-". iTY f';""\.S"('i~ ..\".1,VI~ lo.l'fj ~ "-\'....;,h~ 19.QO Pel {l"-~ R..~ ~SJj~ . /lhlI'C.C m~ (lree{ /YA9~ Ii n' II Jcnnirer C. DcllchR\ln Pa,IlH7277~ MO:<iRAW.IIAIT ol llEITl'IIMAN .. l.ibaty Avenue l"""ide, PA 1701J ""one: C7171249-4lOO Fax: 17171249-4500 Allomcys r~ ~inli" IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Joseph Nesmith, a/k/a Joe Nesmith, Jr., Plaintiff, vs. Nationwide Mutual Insurance Company, Defendant Civil Action - Law Case No,: 97-5491 PRAECIPE FOR DEFAULT JUDGMENT PURSUANT TO PA.R.C.P. IOJ7(b} TO: Prothonotary Please enter default judgment against Defendant, Nationwide Mutual Insurance Company, pursuant to Pa.R.C.P, 1037(b), PlaintifT's counsel hereby CERTIFIES pursuant to Pa,R.C,P, 231.l(a)(2)(ii) that written notice of intention to file the praecipe was delivered to Defendant's counsel of record more than ten days prior to the date of filing thi~ praecipe, Said notice is attached hereto as Exhibit "A." Respectfully submitted, McGRAW, HAlT & DEITCHMAN (Allomeys for Plaintiffi Date: L/j)-J /J F / / B JeMlfer C. It: Pa. ID #72779 4 Liberty A venue Carlisle, PA 17013 Phone: (717) 249-4500 Fax: (717)249-450 CERTIFICATE OF SERVICE I, JENNIFER C, DEITCHMAN, hereby certify that this 291h day of April 1998, I served a copy ofthe foregoing PRAECIPE FOR DEFAULT JUDGMENT IJURSUANT TO PA,R.C.P, 1037(b) upon the following individual(s) or entity(ies) by U.S, First Class postage pre-paid mail: Karen Durkin, Esquire JAMES, SMITH, DURKIN & CONNELL Y P.O. Box 650 Hershey. PA 17033 ~I ~..~ .J ~ (tl f:: c ~~ ., .- -,' ....' UJ~:! 0' j~'~ ~l' - ~. ...:.. .. ~ '.1~;~ )~I ,. C. '.::;"!:~ J.. N I-~ ~~ ii" r-: ,,':tJ il~ U- .',.... .... .....4..... ~ J ~ CD =j Cf\ U ~ f\)~ Vl~ ~W '" ~"<l C1 .0 0 ~ r -J ." , t' r~ ': .'.., . '1"'" It .1 '~ I .,O~ .,-1 '11..:- ..;6 ~', . ,.,\ . 'j :~ .. ,< ) ..<: ' "'II .+. ,.) ~ ;:,' ~ 11\ ,c ,,- :':"! ~ -..:-. '1' -<., fJ '8 r r " Jennifer C, Deitchman (Attorney for Plaintiff) Pa, ID #72779 McGRAW, HAlT & DEITCHMAN 4 Liberty A venue Carlisle, PA 17013 Phone: (717)249-4500 Fax. (717)249-4500 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Joseph Nesmith, aIkIa Joe Nesmith, Jr., PlaintitT. Case No,: q., - 54'1 I C-<.~l N_ COMPLAINT NOTICE vs, Nationwide Mutual Insurance Company. Defendant NOTICE You have been sued in court, If you wish to defend against the claims set forth in the followin pages, you must take action within twenty (20) davs after this Complaint and Notice are served, b entering a written appearance personally or by attorney and filing in writing with the court your defens or objections to the claims set forth against you, You are warned that if you fail to do so. the case ma proceed without you and judgment may be entered against you by the court without further notice for an money claimed in the Complaint or for any other claim or relief requested by the PlaintitT(s), You ma lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NO HA VE A LAWYER OR CANNOT AFFORD ONE. GO TO OR TELEPHONE THE OFFICE SE FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP, Court Administrator Fourth Floor Cumberland County Courthouse Carlisle, P A 17013 (717)697-0371 (717)240,6200 excess of the minimum co~erage required by the Pennsyl~ania Motor Vehicle Financial Responsibility Law ("MVFRL"). 7S Pa,C,S, ~ 1701, fl. f,fq., as amended. 5, On or about June 10, 1993. while said automobile policy was in full force and elTect, Plaintiff was in~ol~ed in a motor ~ehicle collision in which the ~ehicle in which he occupied, the 1966 Cadillace co~ered under the aforementioned policy of insurance, was rear-ended by a ~ehicle dri~en by a third party, 6. Plaintiff suffered injuries as a resull of said collision, namely: a) cervical strain/spmin with spondylosis; b) left shoulder rotator cuff syndrome and shoulder tendonitis; c) lumbar strain/sprain; and d) herniated lumbar disc at L5/S I and compression on the S I nerve root ("left S I mdiculopathy"), 7. As a result of said injuries due to the June 10, 1993 collision, Plaintiff has been obliged to seck and recei~e treatment and care for his injuries, thereby incurring ~arious medical expenses for which medical benefits under the aforesaid policy are payable. Plaintiff is expected to be obliged to continue to recei~e medical care and treatment for the collision-related injures and expend ~arious sums of money for an indefinite period of time in the future for such treatment for her injuries, 8. Plaintiff sought treatment by a specialist, Jay J, Cho, M.D., on or about January 21, 1994, who performed an examination of plaintiff and diagnosed Plaintiff with low back pain with herniated disc and radiculopathy; cer~ical pain with spondylosis and shoulder tendonitis. Thereafter, PlaintitT sought and recei~ed further medical treatment from Dr, Cho and Trindlc Rehabilitation Center, 9. Trindle Rehabilitation Center was the precursor of Rehab Medicine Associates, 10. After initially paying for treatment by Dr, Cho and Rehab Medicine Associates, Defendant submitted the issue of the treatment performed by Dr, Cho and Rehab Medicine Associates to a Peer Review which was performed in March of 1995, 11. It was the reviewer's d<1ermination that "the physical therapy services at the Trindle Rehabilitation Center were medically necessary and were reasonable through 7/31/94 and that the services of Dr, Cho were medically reasonable and necessary through 9115/94," The PRO doctor ..'so opined that "treatment beyond those dates would not be reasonable or necessary lor the motor vehicle accident injuries 01'6/10/93," 12. One factor in the PRO determination was that a fall in July of 1994 during which the PRO report states that Plaintiff "twisted his left ankle and developed severe pain along the left side of his low back," In his "Peer Review Recommendations" the reviewer cites to an "incident" and a "fall" in June of 1994 which, in his opinion, aggravated a pre-existing degenerative arthritis condition and caused bilateral pain, although the reviewer does not cite to a specific finding in his clinical summary to support the assertion that Plaintiff was also experiencing right sided pain. 13. The reviewer thus stated: "Because of the aggravating incident in June [sic] of 1994, it is my opinion that the additional treatment especially the pelvic traction and therapeutic exercises were due to a separate incident which in all medical probability aggravat":d the pre-existing conditions from the June of 1993 accident and also from the underlying degenerative arthritis," 14, Defendant has refused payment for treatment rendered to Plaintiff by Dr, Cho and Rehab Medicine Associates on the basis that such treatment has not been reasonable or necessary, 15. Plaintiff asserts that his fall in July of 1994 was directly related to th.lnjuries he sustained in the June, 1993 motor vehicle accident. The injuries he sulTered in the June 1993 motor vehicle accident were a proximate cause of his fall and thus any treatment for injuries related to the fall arise out of the motor vehicle accident. 16, As an alternative to the above paragraph, the fall did not cause an exacerbation a pre,existing arthritic condition. but rather aggravated the disc herniation caused by the June 1993 motor vehicle accident. and is tbus related, 17. As such. PlaintilT contcnds that all of his treatment relaled to his low back impairments and radiculopathy which has been provided by Dr, Cho and Rehab Medicine Associates is reasonable and necessary and related to the June 1993 motor vehicle accident. 18, Additionally, Plaintitl'treals with Dr, Cho and Rehab Medicine Associates for other injuries sustained in the June. 1993 accident. namely neck and shoulder pain, which Defendant was aware of at the lime that it submitted the issue of Dr, Cho's treatment to the PRO. 19, PlaintitT. therefore claims that Defendant improperly invoked the PRO process to deny him benefits for treatment of injuries which were causally related to the June, 1993 vehicle collision; lhat said treatment was and continues to be reasonable and necessary. and that the PRO determination was done in bad faith and with reckless disregard for the contractual and legal rights of PlaintilT. 20. Under the MVFRL, peer reviews are not to be used to determine the causal nature of treatment. 21, The PRO at issue concludes that the fall in June or July of 1994; not the June. 1993 motor vehicle accident is the cause of the pain for which Mr, Nesmith treated with Rehab Medicine Associates after 7/31/97 and with Dr. Cho after 9/15/94, As such. this is an improper determination under the PRO procedures allowed under the MVFRL. 22. The amount of unpaid bills known to Plaintiff as of June of 1997 was $982.00, Moreover. PlaintilT has undertaken to make payments for such treatment on his own, or through other insurance coverage available to him, The amount of bills paid by sources other than Nationwide for treatment rendered after 7/31/94 by Dr, Cho and Rehab Medicine associates is approximatcly $889.00. 23, The care which Dr. Cho and Rehab Medicine Associates have provided has been reasonable and necessary and is related to the injuries sustained in the June 10, 1993 collision, 24, It is anticipated that PlaintilT will require continuing care and treatment and surgery is contemplated to allemptto alleviate PlaintitT's painful back condition. 25. Defendant's refusal to pay for the reasonable and n.'Cessary care of Plaintirrs injuries nnd its submission of Dr, Cho and Rehab Medicine Associates' billings to a PRO violate both the applicable insurance polley and the MVFRL. 26. Defendant's refusal to pay for the reasonable and necessary treatment of Plaintitrs injuries on the basis ofa PRO determination that certain lreatmcnts after 7/31/94 and 915/94 were not casually related to the June 10, 1993 motor vehicle collision Is outside of the scope of Act 6, Denials for payments for further treatments have thus been made in bad faith in violation of42 Pa,C,S,A. ~8371. WHEREFORE, Plaintiff claims damages in the amount of: a) any unpaid bills by Defendant for Dr. Cho and Rehab Medicine Associates; b) reimbursement for payments made by Plaintiff and/or any third parties for treatment rendered by Dr, Cho and Rehab Medicine Associates; c) as well as interest in the amount of the prime rate plus 3%; d) allomey fees; e) costs ohuit; I) punitive damages; g) and an order requiring Defendant to either payor challenge all future bills for treatment related to the June 10, 1993 motor vehicle collision in accordance with the MVFRL. h) and any other remedy the court deems appropriate, I 'I .. i) The ~alue of Ihis aelion is !!!1l in eKeess of $25,000, 1 ' Daled this 61h day ofO~ )),9;7 . -11-'--" By: c/ 1/1 J' mnifer C. Deitehman Pa. ID #72779 MeORA W, HAlT &. DEITCHMAN 4 Liberty A ~enue Carlisle, PA 17013 Phone: (717)249-4500 Fax: (717)249-4500 AFFIDA vir I verify that the statements made in the foregoing Complaint are trut and correct to the best of m knowledge, information. and belief, The language is that of counsel. but ( have reviewed it for it accuracy and I acknowledge that any false statements herein are made subject to the penalties of 18 Pa C.S,A. Section 4904 relating to unsworn falsification to authorities. Dat~' //~J~~~-:> , ( ( ;7 ,-~~ / fL< <;;r;; ,~~ ~'", ./ , ..-/ ..." /L c' Joseph Nesmith. alkJa Joe Nesmith, Jr, i. . . . ' :I: .... E > :I: ::: ~ ~ ;ll .. Vl!: z o ::: " 7- VI ~ ~ 0 .. r-' " " ::l :> ~ Ro Q z :; 0 2i c:: .... ~ ~ Z () U) (') ~ .... ~i' ~f" -- ,., d ":" [~~; ..:: r . I i' ~ .<-,", 'qn, r~~ '" (..) 1 ,oJ ';' ,'A i~.l:} '':j' , ~': '. 'il ~:C.l '.'4.'1 ';1(") ,'-i) ~~; l)lll J:'--t'" :lJ ., ,::> ~ :', I,) .... co, . ',~ " :J: .... ," .,,1 ,\ '" > " . i:l :: 'I 1,:,-, " ') '" ~ ' ',-- :< \ "l ril 1._' ~.-J " CIl !;' ;,:") :z :: J :z p ~ '" ::j . -< ~ 0 ',Ill .... ::t: ' , < '" :!l .'" ,I > '" p,. :'1 ';j :z n I ;: is '" - '" .<; 0 c3 c:: ... ~ ... ~ - Z initially paying for treatment by Dr. Cho and Rehab Medicine Associates". 6, Paragraph fourteen (14) of Plaintiff's complaint alleges that "Defendant has refused payment for treatment rendered to Plaintiff by Dr. Cho and Rehab Medicine Associates on the basis that such treatment has not been reasonable or necessary". 7. Pa.R.C,P, 1019{f) requires that "averments of time, place and items of special damages shall be specifically stated." 8, The aforementioned paragraph ten (10) fails to state specifically the time period or dates corresponding with the phrase "initially" used by Plaintiff to indicate prior instances of payment by Defendant, 9. The aforementioned paragraph fourteen (14) fails to state in any respect the time or date of Nationwide's denial of coverage or refusal to pay for Plaintiff's medical treatment. 10. Paragraph nineteen (19) of Plaintiff's complaint purports to allege bad faith on the part of the Defendant by alleging that "Defendant improperly invoked the PRO process to deny him benefits for treatment of injuries that were causally related to the June 1993 vehicle collision; that said treatment was and continues to be reasonable and necessary, and that the PRO determination was done in bad faith and with reckless disregard for the contractual and legal rights of Plaintiff". 11, Paragraph twenty-one (21) of Plaintiff's complaint purports to allege bad faith on the part of the Defendant by alleging that Defendant's Peer Review constituted "an improper determination under the PRO procedures allowed under the MVFRL". 12, Paragl'aph twenty,five (25i of Plaintiff's complaint purports to allege bad faith on the part of Defendant by alleging that "Defendant's refusal to pay for the reasonable and necessary care of Plaintiff's injuries. ,violates both the applicable insurance policy and the MVFRL" , 13. Paragraph twenty-six (26) of Plaintiff's complaint purports to allege bad faith on the part of Defendant by alleging that "Defendant's refusal to pay for the reasonable and necessary treatment of Plaintiff's injuries, . . is outside of the scope of Act 6", 14, Pa. R,C.P. 1019(a) requires that material facts on which a cause of action is based shall be stated in a concise and summary form. 15. The aforementioned paragraphs nineteen (19), twenty-one (21), twenty-five (25), and twenty-six (26) of the Plaintiff's Complaint containing bare allegations of reckless and unreasonable conduct fail to set forth with sufficient specificity the material facts on which a cause of action for bad faith may be based. 16. Plaintiff's Complaint lacks sufficient specificity to apprise Defendant of the issues to be litigated, to allow it to adequately prepare to assert defenses to Plaintiff's allegations. WHEREFORE, Defendant Nationwide respectfully requests this Honorable Court order Plaintiff to more specifically plead the averments of paragraphs Ten (10), Fourteen (14), Nineteen (19), Twenty'one (21), Twenty-five (25), and Twenty-six (26) of his Complaint. PRELIMINARY OBJECTION RAISING FAILURE OF PLEADING TO CONFORM TO LAW OR RULE OF COURT Defendant, by its undersigned attorney, preliminarily objects to Plaintiff's Complaint pursuant to Pa, R,C,P. 1028(a) (2) as follows: 17, Paragraphs eleven (11) through thirteen (13) of Plaintiff's complaint contain allegations based upon the report generated by the Peer Review Organization. 18. Paragraph twenty-two (22) of Plaintiff's complaint contains allegations purporting the amount of unpaid medical bills and suggests that "Plaintiff has undertaken to make payments for such treatment on his own, or through other insurance coverage available to him", 19. Pa, R.C.P, 1019(h) requires that" [al pleading shall state specifically whether any claim or defense set forth therein is based upon a writing. If so, the pleader shall attach a copy of the writing . " 20. The Plaintiff failed to attach the documents mentioned specifically in paragraphs eleven (11), twelve (12), thirteen (13), and twenty-two (22) of the Complaint, WHEREFORE, Defendant Nationwide respectfully requests this Honorable Court order Plaintiff to attach a copy of the writings relied upon in paragraphs Eleven (11), Twelve (12), Thirteen (13), and Twenty- two (22) of his Complaint to his answer to these preliminary objections. Exhibit A Jennifer C. Deitchmun Pa. ID #72779 McGRAW, HAlT & DEITCHMAN 4 Liberty A venue t Carlisle, PA 17013 Phone: (717)249-4500 Fax: (717)249-4500 ~ Attorneys for Plaintiff , IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Joseph Nesmith, nlk/a Joe Nesmith, Jr" Plaintiff, Civil Action - Law Case No,: q 7 - S-Y?, fu.:.I -r..L- vs. Nationwide Mutual Insurance Company, . COMPLAINT Defendant \, Plaintiff, Joseph Nesmith, nlk/a Joe Nesmith, Jr., is an adult Individual residing at 424 Fairground Avenue, Carlisle, Cumberland County, PA 17013. 2, Defendant, Nationwide Mutual Insurance Company, is a company duly licensed to transact business in the Commonwealth of Pennsylvania, Defendant maintains a place of business at 1000 Nationwide Drive, Harrisburg, Dauphin County, Pennsylvania, 3, Prior to June 10, 1993, Defendant issued to Plaintiff a policy of automobile insurance bearing number 5837 C 311026, 4. Thc insurance policy provided for $100,000,00 in First Party Medical Loss Benefit coverage on both vehicles covered under the policy, a 1976 Cadillac and a 1977 Ford Pickup, which amount was in 17. As such, PlaintifT contends that all of his trealment related to his low back impairments and radieulopathy which has been provided by Dr, Cho and Rehab Medicine Associates is reasonable and - necessary and related to the June 1993 motor vehicle accident, 18, Additionally, PlaintifTtreats with Dr, Cho and Rehab Medicine Associates for other injuries sustained in the June, 1993 accident, namely neck and shoulder pain, which Defendant was aware of at the time that it submitted the issue of Dr, Cho's treatment to the PRO. 19, PlaintiO; therefore claims that Defendant improperly invoked the PRO process to deny him benefits . for treatment of injuries which were causally related to the June, 1993 vehicle collision; that said treatment was and continues to be reasonable and necessary, and that the PRO determination was done In bad faith and with reckless disregard for the contractual and legal rights of PlaintifT. . 20. Under the MVFRL, peer reviews are not to be used to determine the causal nature of treatment. .L 21, The PRO at issue concludes that the fall in June or July of 1994; not the June, 1993 motor vehicle . accident is the cause of the pain for which Mr, Nesmith treated with Rehab Medicine Associates after 7/31/97 and with Dr, Cho after 9/1 5/94, As such, this is an improper determination under the PRO procedures allowed under the MVFRL, 22, The amount of unpaid bills known to Plaintiff as of June of 1997 was $982,00, Moreover, PlaintifT has undertaken to make payments for such treatment on his own, or through other insurance coverage available to him, The amount of bills paid by sources other than Nationwide for treatment rendered after 7/31/94 by Dr. Cho and Rehab Medicine associates is approximately $889,00, 23, The care which Dr, Cho and Rehab Medicine Associates have provided has been reasonable and necessary and is related to the injuries sustained in the June la, 1993 collision, 24. It is anticipatcd that PlaintifT will require continuing care and treatment and surgery is contemplated to allemptto alleviate PlaintifT's painful back condition. CERTIFICATE OF SERVICE I, KAREN DURKIN, ESQUIRE, do hereby certify that I served a true and correct copy of the foregoing Preliminary Objections upon the following below-named individual(sl by depositing same in the U. S. Mail, postage pre-paid at Hershey, Dauphin County, Pennsylvania this ~ ,~ day of December, 1997. SERVED UPON: Jennifer C, Deitchman, Esquire McGraw, Hait & Deitchman 4 Liberty Avenue Carlisle, PA 17013 r Durkin, Esquire JAMES, SMITH k DURKIN . ... i,,-i I;' '(; ,..,. >,j-; .,' ,',.1' r t._ ._~_'.LL!LEr_1..t;,. _____.._._.___ :; :\: :; :1'l:.I!) r .._JUiILJ.~:\~.__~ II: 'iJ)Bllli> ~:~_...0.~1 F.L..~..ILL~.:~.L..:_..l~-L!.l:'::""_ . Shc';: i. it, ...hu b~'l_fj-;) ;:.fu ly .c;'fIorr. aCC(l,f d 1 fig ,.... :-;]y:i. that h'~' m:.Jrjt:':" " di. Ll'J,.:'nt 8(;\8t'ch 3nd iriquir'/ 10': t.he 'oI:tthlI1 1,; [':.,r; -}'jflt.. 1:.0 ....1 ~: __tl!\TIC:!IWr['E ~!UrUi\L In::.;Ul'~.;W:':E ...~___~.__._,_._______.____---!= CJtJF A ~t Y ',} !~- I., i, ~l b l'~o to 10': ~ t.~;. Th.,;:' ill In t~~s b~~l~w~ck. }!;,;,:. thQr'c:.tfJrt'-' i':';';lf~ --,;<,j (h,:: ~:;h._lrlfr: '].f Ui\Uf.'H UI (-'Cj~JnTY Cf)Un t y, f'~:;nn:;)" 1 v;:jn .l,.:t. t, "j '.'(' t.h,,-- W 1 r.h in __i';'i2'1r-!.i\Jl!T !"f~ j-2~~~b':,,! __20th, --):,7 th.10 0ftl<.::~:.:-' j.;f~;.J J.n r;,:.:c-2J..pl oi . I,. I' !:.{j"~.:h,~~,j l.~.;:.ttlcn ff"(Jf'1 ['AUf-liI!! C'UUnT'{ C(,un t i, F'~~nn3i'1 Vdn ia. -I ~ J j ,; I",.' ,,+.. : I 'i'.' ~ r: lj It '-'f ;~'Junt)' 'J: (:h'-_lt-'l'-' [I,; IJt" f! [ n - ;~Oi.JNTY l,rj. :~JU ':),00 _~. (DC' 29. _,; ::;'J~"~": ..;,. ;;t,_-)~"r-" ..'~T:;<'<~"'" '1 ' .. I" _ j, d~" ,.... ,.., ,., ~ _ .... .... '~'1:-:~ NC':;f~j\W rlAIr \.~ :'". r ET":::llrL\U 1 '.,;~ . ~",J 1 '.~' i;"j ~-::lJt:::O;'_-:i'-lb'2.,d t.,:) b.~-t':Jr< n~<' . , .J.tl~ ----------- ,I J/ '.'..1. CP L.W........ _ q 1.... " ~-~";:~c~~~:.:.r,,~~ , Office of the Sheriff Mary Jane Snyder \~eal L:ilole OopulV Ralph Q, McAllister Chief Ouputy Michael W. Rinehart AI..llanl Chlo' Doputy Wilham T, Tully 80llcllor Douphin Counly Hnrrl6bUlg, P(Jnn6~hill,njil1/101 (/11) 255 2660 J. R. Lotwick Sheriff COMMONWEALTH OF PBNNSYLVANIA COUNTY O~ DAUPHIN SHBRIFF'S RETURN No. 2309-T - - -97 OTHER COUNTY NO. 97-5491 AND NOW. October 14, 1997 at 11120AM served the within COMPLAINT (, NOTICE upon NATIONWIDE MUTUAL INSURANCE CO. by personally handing to AMY PATTON - ADMIN SECRETARY 1 true attested copy ( ies) of the original COMPLAINT,. NOTICE and making known to him/her the contents thereof at 1000 NATIONWIDE DR. HARRISBURG, PA 00000-0000 Sworn and subscribed to S;C ~.T~a~19" I PROTHONOTARY S~f~ ~eriff of Dauphin C nty, Pa, Sheriff's COStSI $29.25 PD 10/09/97 RCPT NO 101974 RB JoseP41 Nesmith a/kid ,Joe Nesmith. ,Jr. \'S. Nationwide Mutual Insurance Crnnpany No, 97-5491 Civil Term 19_ Now, Dc t. 8. Dauphin 1997 19_,1 SHERIFF Of Cl'MBERLA:'o1> COl'>'iTY, PA do bmb~ deputize Ibe SberlffoC COUDl)' 10 UICUlllhls Writ, Ihls depulalloD belni made al tbe request and risk oftbe Plalnlirr, .~~~ r .. -r.-e;;<- c..f' Sheriff oC Cumberland Counl), Pa. Affidlwit of Sen'ice ~.ow, 19 .01 o'clock ~I, sel'\'ed Ibe within UpOD at by b3ndi[J~ fa artelled cop~' of tbe oriilDol Ibe contenlS IblreoC. a true and and made known 10 So answers, .... Sberlff DC Counl), Pa. COSTS S"orn and lub,cribed beCore me thi~ da~. or 19_ SERVICE MILEAGE AFFIDA HT s s . ;, . c) ~ .: I , .' . '-'J --- \.n ~:' " 1 , ." CJ :.:..J :.J '.J n "" I , ,'1 , ',-' 'I . \ ~J , - i() , J I llll . '. J! -, J~nnirer C. Ddlchman (Attorney llJr Plainlin) I'a. ID #72779 McGRAW, HAlT & DEITCH MAN 4 Liberty A venue Carlisle,I'A 17013 I'hone: (717)249-4500 Fax: (717)249-4500 IN TIlE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, I'ENNSYL VANIA Joseph N~'Smith, alkla Joe N.'Smith, Jr., PlaintitT, Case No.: 97-5491 Civil Action - Law vs. AMENDED COMPLAINT NOTICE Nationwide Mutual Insurance Company, Defendant NOTICE You have been sued in court. If you wish 10 defend against the claims set forth in the followin pages, you must take action within tw:ntv (20) davs aller this Complaint and Notice are served, b entering a written appearance personally or by attorney and tiling in writing with the court your de fens or objections to the claims sct forth against you. You arc warn cd that if you fail to do so, the case ma proceed without you and judgmcnt may be entered against you by the court without further notice for an money claimed in the Complaint or for any other claim or relief requested by Ihe PlaintitT{s). You ma lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NO HA VE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SE FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Court Administrator Fourth Floor Cumberland County Courthouse Carlisle,PA 17013 (717)697-0371 (717)240-6200 Jennifer C. Deilchman Pa. ID #72779 McGRA W. IlAIT & DEITCIlMAN 4 Liberty A venue Carlisle. PA 17013 Phone: (717)249-4500 Fax: (717)249-4500 ~,' Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY. PENNSYLVANIA Joseph Nesmith. a/k1a Joe Nesmith. Jr.. Plaintiff. Civil Action - Law Case No.: 97-5491 vs. AMENDED COMPLAINT Nationwide Mutual Insurance Company, Defendant In response to the Preliminary Objections tiled by Defendant on or about the 5th day of December, \997, Plaintiff hereby tiles this Amended Complaint in the above-captioned action: I. Plaintiff, Joseph Nesmith, a/k1a Joe Nesmith. Jr.. is an adult individual rL'Siding at 424 Fairground Avenue, Carlisle, Cumberland County, PA 17013. 2. Defendant. Nationwide Mutual Insurance Company, is a company duly licensed to transact business in the Commonwealth of Pennsylvania. Defendant maintains a place of business at 1000 Nationwide Drive. Harrisburg. Dauphin County, Pennsylvania. 3. Prior to June 10,1993, Defendant issued to Plaintiffa policy of automobile insurance bearing number 5837 C 3\1026. 4. The insurance policy provided for $\ 00,000.00 in First Party Medical Loss Benefit coverage on both vehicles covered under the policy, a \976 Cadillac and a 1977 Ford Pickup. which amount was in excess of the minimum coveragc rC4uired hy the Pcnnsylvania Motor Vchicle Financial Responsibility Law ("MVFRL"), 75 I'a.es. Ii 1701. el, e"q,. as amendcd. 5. On or about June 10, 1993. while said automobile policy was in full force and etTect. Plaintiff was involved in a motor vehicle collision in which the whicle in which he occapied. the 1966 Cadillac covered under the aforementioned policy of insurance. was rear-ended by a v~hiclc driven by a third party. 6. PlaintitT sulTered injuries as a r~'Sult of said collision. namcly: a) cerllical strain/sprain with spondylosis; b) lel\ shoulder rotator cuff syndrome and shoulder tendonitis; c) lumbar strain/sprain; and d) herniated lumbar disc at LS/5 I and compr~'Ssion on the 5 I nerlle root ("Iel\ S I radiculopathy"). 7. As a resalt of said injuries due to the June 10, 1993 collision. Plaintiff has been obliged 10 seck and receive treatment and care for his injaries. thereby incurring various medical expenses for which medical benefits under the aforesaid policy arc payable. PlaintitT is expected to be obliged to continue to receive medical care and treatment for the collision-related injures and expend various sums of money for an indefinite period of time in the future for such treatment for her injuries. 8. Plaintiff sough I treatment by a sp,'Cilllist. Jay J. Cho. M.D,. on or about January 21. 1994, who performed an examination of plaintiff and diagnosed Plaintiff with low back pain with herniated disc and radiculopathy; cervical pain with spondylosis and shoulder tendonitis. Therealler. Plaintiff sought and received further medical treatment from Dr. Cho and Trindle Rehabilitation Center. 9. Trindle Rehabilitation Center was the pr.'Cursor of Rehab Medicine Associates. 10. Aller initially paying for treatment by Dr. Cho and Rehab Medicine Associates. Defendant submiued the issue of the treatment performed by Dr. Cho and Rehab Medicine Associates to a Peer Review which was performed in March of 1995. A true and correct copy of said Peer Review Report is attached hereto as Exhibit" A." II. It was the reviewer's determination that "the physical therapy serviees at the Trindle Rehabilitation Center were medically necL'Ssary and were reasonable through 7/31/q4 and that the services of Dr. Cho were medically reasonable and necL'Ssary through 9/15/Q4." The PRO doctor also opined that "treatment beyond those dates would not be reasonable or necessary "'r the motor vehicle accident injuries 01'6/10/93." (See Exhibit "A"), 12. One factor in the PRO determinatiGn was that a lall in July of 1994 during which the PRO report states that Plaintiff"twisted his lell ankle and developed severe pain along the left side of his low back." In his "Peer Review Reeommendations" the reviewer cites to an "incident" and a "fall" in June of 1994 which, in his opinion, aggravated a pre-existing degenerative arthritis condition and caused bilateral pain, although the reviewer does not cite to a spL"Cific finding in his clinical summary to support the assertion that PlaintilT was also experiencing right sided pain. (See Exhibit "A"). 13. The reviewer thus stated: "Because of the aggravating incident in June [sicl of 1994, it is my opinion that the additionaltrcatmcnt especially the pelvic traction and therapeutic exercises wcre due to a separate incident which in all medical probability aggrnvatL'll the pre-existing conditions from the June of IQ93 accident and also from the underlying degenerative arthritis." (See Exhibit "A"). 14, Defendant has refused payment for treatment rendered to Plaintin'by Dr. eho and Rehab Medicine Associates on the basis that such treatment has not been rcasonable or nccL'Ssary. A true and correct copy of Defendant's notification that it would not pay further benefits is attached hereto as Exhibit HB." 15. Plaintiff asserts that his fall in July of 1994 was dirL'Ctly related to the injuries he sustained in the June, 1993 motor vehicle accident. The injuries he sufTered in the June 1993 motor vehicle accident were a proximate cause of his lall and thus any treatment for injuries related to the fall arise out of the motor vehicle accident. 16. As an alternative lu the ahove panlgraph, Ihe f'llI .!i.! nol cause an exacerbaliun a pre-exbling artbrilic con.!ition. but rather aggraval.-.J the .!isc herniation cause.! by Ihe June 1993 motor vehicle accidenl. an.! is Ihus relale.!. 17. As such. Plainlitl'conlen.!s Ihal all of his Irealment relaled 10 his low back impairmenls an.! ra.!iculopalhy which has been provi.!e.! by Dr. Cho an.! Rehab M.-.Jicine Associllles is reasonable and nec.ossary an.! relate.! to the June 1993 motur vehicle acci.!en\. 18. Ad.!itionally. Plainlitftreats with Dr. Cho an.! Rehab M.>dicine Associates for other injuries sustained in the June, 1993 aeci.!ent. namely neck an.! sholJI.!er pain. which Defen.!anl was aware of at the time that it submilled Ihe issue of Dr. Cho's treatment 10 the PRO. 19, PlaintiIT. therefore claims that Defendant improperly invoked the PRO process to deny him benefits for trealment of injuri.'S which were causally relate.! to the June. 1993 vehicle collision; that said treatment was an.! conlinues 10 be reasonable an.! ne<:essary. an.! thaI the PRO determination was done in bad faith and with disregar.! for the contractual and legal rights of PlaintiIT. 20. Under the MVFRL. peer reviews are not 10 be use.! to determine the causal nature of Ire at men\. 21. The PRO at issue conclu.!es that the fall in June or July of 1994; nolthe June, 1993 motor vehicle acci.!ent is the cause of the pain for which Mr. Nesmith Ireated wilh Rehab Medicine Associates after 7/31/97 and with Dr. Cho after 91:5/94. (See Exhibit "A"). This factual basis. namely causation. which forms Defendanl's reason for denying payments is an improper determinalion under the PRO proce.!ures allowed under the MVFRL. E.g.. Neun v. Slale Farm. E.D. no.95-7577 (5/2/96); Pierce v. Slate Farm Insurance COmDany. CP Lackawanna 10/20/94 (PICS No. 94-2129). 22. The amount of unpaid bills known to PllIintitl' as of June of 1997 was $982.00. Moreover, PlaintiIT has undertaken to make payments for such Ireatment on his own. or through other insurance coverage available 10 him. The amount of bills paid by sources other Ihan Nationwide for trealment rendered after 7/31/94 by Dr. Cho an.! Rehab M.>dicine associates is approximately $889.00. Copies of account statements concerning Plaintill"s care arc attached hereto as Exhibit "C." 23. The care which Dr. Cho and Rehab Medicine Assnciatc'S have provided has been reasonahle and necessary and is related to the injuric'S sustained in the June 10, 1993 collision. 24, It is anticipated that Plaintil1' will require continuing care and treatment and surgery is contemplated to attempt to alleviate Plaintiff's painful back condition. 25. Defendant's refusal to pay lor the reasonable and necessary care of Plaintiffs injuries and its submission of Dr. Cho and Rehab Medicine Associates' billings to a PRO violate both the applicable insurance policy and the MVFRL. 26. Defendant's refusal to pay for the reasonable and nc"Cessary treatment of Plaintil1's injuries on the basis of a PRO determination that certain treatments after 7/31194 and 915/94 were not casually related to the June 10, 1993 motor vehicle collision is outside of the scope of Act 6. Denials for payments lor further treatments have thus been frivolous and unfounded in violation of 42 Pa.C,S.A, ~8371 , WHEREFORE, PlaintilT claims damages in the amount of: a) any unpaid bills by Defendant lor Dr. Cho and Rehab Medicine Associates; b) reimbursement for payments made by Plaintil1' and/or any third parties for treatment rendered by Dr. Cho and Rehab Medicine Associates; c) as well as interest in the amount of the prime rate plus 3%; d) attorney fees; e) costs of suit; l) punitive damages; g) and an order requiring Defcndantto either payor challenge all future bills for treatment related to the June 10, 1993 motor vehicle collision in accordance with the MVFRL, h) and any other remedy the court deems appropriate. i) The value of this action is not in cxeess of $25,000, By: . ennili:r . Deite inan Pa. ID #72779 McGRAW, f1AIT & DEITCflMAN 4 Liberty A venue Carlisle, P A 17013 Phone: (717)249-4500 Fax: (717)249-4500 HOME OFFICE 6618 BLACK HORSE PIKE' CARDIFF. NJ 081Jl '609'641'UOO r A REGIONAL OFFICE 110 8ETHLEHEM PIKE, r,o, UOX ~t.I" COI.MAR. PA 18915.0566 11151 997.8413 p,...It;Unl 1McJ1c.,OltKtaf J W F'ltltl.f,DO Work.,. COIf1IMnu/1on WP SIIlU, ODS UD JW F,~l"lf, 00 PC Ronl,OO JO St.n Phy.h;'-n. JW F~lltr.OO PC Roul,DO.JD L lalla. 00 PI..t~ 5UfTlMY B G.nt." ... 0 U Ru. M 0 IHurcuurgMy JAnco, ... 0 Ortflop<<1lc 'UIV<<Y . Z T.rmanll'll,"'O . J T COlon., lot D. . A J, SaroIlt\an,MO. J. Lettman, M 0 G.~I SurgMM J A Qoo.ty..r, M 0 In,.rnM "<<Skin. . A M GoUup, MO RIw..-oIogy 5 Hoch, MD H..._ D. S.UI. M 0 J. Ho..y. MO br-No... J'hro.t D. A &J)trman, MO. NlUl"OfnycllIMry Said Shanawanl, M 0 N.uroptychology JL Johnton. PtI0 W.O. McCown. PhO. Phy.1cAI "-dIe/M .,.4 Rehab. N, Zemel. MD R. Whartn. M D. -1oIoVt o D.mchuk, M 0 Dent,.,,, W Kenny,O,MO. 000 E. Miln.r, 0 D,S Poyc_ O. Walral, Ph.D . J H Schuhwl, Ph 0 Chlrnprat:tlc . R. Tuhl*1, DC G HOlM)'. DC B RothanbefTJer. 0 C M Cav.Do. 0 C PodI.try M Sloul, 0 P M . NorthJ8fl'Yonly .. Manhattan only March 2, 1995 Ms. Debra Davis Nationwide Insurance company P.O. Box 2655 Harrisburg, PA 17105 Re: Joseph Nesmith Claim I: 5837C 311026 06109301FPB IMC I: 2869PA Dear Ms. Davis: At the request of Independent Medical Consultants, I reviewed certain medical records which were submitted to me on the above named individual. These records included the following: 1. Reports from the Carlisle Hospital Emergency Room, dated 6/10/93. 2. X-ray report of 6/10/93 of the thoracolumbar spine. 3. Reports from the office of Dr. Kipp from 6/11/93 through 6/28/93. 4. Reports from the office of Dr. Thomas J. Green, M.D. from 7/15/93 through 12/29/93. 5. Reports from the offices of the Rehabilitation Medicine Associates and Dr. Cho from 1/21/94 through 12/2?/94. 6. Reports from the Alexander spring Rehabilitation Center of Carlisle pennsylvania from 7/22/93 through 8/24/93. 7. Records from the East Shore Rehabilitation Center from 10/7/93 through 1/27/94. 8. Records from the Trindle Rehabilitation Medicine Center from 1/24/94 through 12/14/94. 9. Records from the seidle Memorial Hospital of Mechanicsburg, Pennsylvania for a hospitalization from 5/9/94 through 5/24/94. 10. Copies of diagnostic studies which included the following: CT Scan of the lumbosacral spine, dated 6/24/93; MRI Scan of the Lumbosacral Spine, dated 8/10/93; EMG, dated 8/13/93; MRI Scan of the Lumbosacral Spine, dated 1/21/94; X-ray of the cervical and lumbosacral spine, dated 1/24/94; x-ray of the left shoulder and EXHIBIT I A Centers IocBlfld IhlOuoh<lU' Now Jorsey, Peflllsylvanld ,nd Mdntlarr.tn Nesmith, Joseph Page 2 cervical spine, dated 5/10/94; EMG report of 1/25/94; MRI Scan of the Left Shoulder, dated 5/12/94; Chem Profile, dated 617/94 and EMG Report, dated 9/6/94. 11. copies of prescriptions for medication, diagnostic studies and therapy. CLINICAL SUMMARY According to the records, the claimant was reportedly involved in a motor vehicle accident which occurred on 6/10/93. He was fifty- eight years old at the time of the accident and was a restrained driver of a vehicle that was rear ended by another vehicle. He went to the Emergency Room at the Carlisle Hospital with complaints of neck pain. X-rays of the cervical and thoracic spine in the Emergency Room revealed degenerative arthritis of the cervical spine without any evidence of acute abnormalities. The claimant was diagnosed with neck and back strain, given prescriptions for anti-infl~mmatory medications and recommendations to apply moist heat and follow up with his Family Physician. It should be noted that the records indicate thnt the claimant's past medical history was significant for a ruptured disc from the 1970's, stomach ulcer, degenerative joint disease and past nasal surgery. The claimant did undergo an evaluation by his Family Physician, at which time he was having complaints of cervical and lower back pain. These evaluations and treatment from his Family Physician took place throughout June of 1993 at which time the claimant was diagnosed with degenerative disease, cervical and back strain. It was in June of 1993 that the claimant underwent a CT Scan of the lumbosacral sprain which showed some slight disc bulging at L4-L5 along with advanced degenerative disc disease at the lumbosacral level and evidence of a degenerative disc herniation at the L4-L5 level. The claimant was referred to an Orthopedic Specialist who felt that the claimant had sustained a low back strain from the motor vehicle accident and was left with a residual sacroiliac syndrome. The claimant was subsequently referred to the Alexander Spring Rehabilitation Facility for a course of outpatient physical therapy treatments from July through August of 1993. These treatments consisted of moist heat, ultrasound, massage and therapeutic exercises. The claimant underwent an MRI Scan of the Lumbar Spine on 8/10/93 which revealed a disc herniation at L5-S1 and some compression on the SI nerve root. An EMG study in August of 1993 was interpreted as being within normal limits. The claimant was subsequently referred by Dr. Green to the East Shore Rehabilitation Center for further physical medicine Nesmith, Joseph Page J evaluations and treatment. This treatment took place from October of 1993 through January of 1994. Despite these treatments, however the claimant continued to experience primarily neck and lower back pain. He was referred to the Rehabilitation Hedicine Associates in January of 1994. Dr. cho evaluated the claimant and Lelt that he had a radiculitis and a herniated disc of the lumbar spine. There was some history in Dr. Cho's notes of the claimant having one episode of bladder and bowel incontinence. This happened in January of 1994. The claimant was referred to the Trindle Rehabilitation Center for additional physical therapy modalities. Another EHG study was obtained in January of 1994 which was consistent with a left Sl radiculopathy and another HRI Scan revealed a herniated disc at L5-S1. The claimant was placed on corticosteroid therapy along with the physical therapy treatments. He also underwent an epidural steroid injection in Harch of 1994 and received anti-inflammatory medication. He was followed on a regular basis by Dr. cho who noted by April of 1994 that the claimant had undergone a series of epidural steroid injections. By that time, the claimant's radicular pain in the left leg had subsided but he was still having complaints of lower back pain, neck pain and left shoulder pain. It was recommended that he continue with physical therapy treatments, anti-inflammatory medication and Darvocet. Despite this treatment, the claimant continued to have persistent complaints of pain and he was eventually admitted into a hospital for approximately two and a halL weeks for additional treatment including intravenous Decadron. It was also LeI t that the claimant possibly had a rotator cuff injury of the left shoulder and an HRI Scan was obtained in Hay of 1994 which was noted to be within normal limits. By early June of 1994, it was felt that the claimant was doing better. His only complaint at that time was fatigue and blurry vision. It was felt that the claimant's radiculopathy of the left Sl and left C5 nerve roots had improved. It was also felt that the cervical spondylosis had improved. In July of 1994, another progress note referred to another injury which occurred in front of a restaurant in which the claimant twisted his left ankle and developed severe pain along the left side of his lower back. Prior to that the claimant was receiving therapeutic exercises to the cervical and lumbar region as well as work simulation treatments in physical therapy. Following the incident in July of 1994, further outpatient physical therapy was recommended. The claimant continued to undergo regular evaluations by Dr. Cho from July of 1994 through January of 1995. Another EHG study was obtained in September of 1995 which showed an acute L5 radiculopathy along with a chronic Sl radiculopathy. The claimant was switched to Daypro and Relafen and continued with stretching activities and therapeutic exercises. It should be noted that the claimant was placed on bed rest in August of 1994 because of an aggravation of his symptoms and findings of muscle spasms in the lower back. ", Nesmith, Joseph Page 4 In October of 1994, the claimant was referred for another epidural injection at which time it was felt that if the symptoms did not improve that he might need a surgical opinion. The claimant was taking Relafen at that time and continued to primarily have complaints of lower back pain. Because of those symptoms in october he was started with a course of pelvic traction, which improved his symptoms. This was continued twice a week for a period of eight weeks along with the Relafen and exercises. The claimant was again evaluated in December of 1994 at which time he was still having complaints of lower back pain and this was associated with some weakness in his lower extremities. The claimant was recommended to continue taking anti-inflammatory medication and pelvic traction. PEER REVIEW RECOMMENDATIONS Based on a review of the records, it is my opiniolJ that it was medically reasonable and necessary for this claimant to undergo evaluations and treatment recommended by Dr. Jay cho for the alleged motor vehicle accident injuries of 6/10/93. Although the claimant did have a pre-existing history of degenerative disc disease, at least three diagnostic studies did reveal evidence of a herniated disc at L5-S1 and this was associated with EHG findings of an L5-S1 radiculopathy. The records indicate that the claimant made satisfactory progress with various forms of treatment including physical therapy, steroid treatments and epidural steroid blocks through June of 1994. In late June the claimant sustained another injury which aggravated his lower back pain primarily on the left side. He did, however go on to experience the pain not only on the left side, but also on the right side as well. Because of this second incident, the claimant continued to require various forms of physical therapy treatments, pelvic traction, medication and office evaluations. with respect to the injuries that could be considered motor vehicle accident injuries of June of 1993, it is my opinion that the evaluations by Dr. cho through 8/23/94 were reasonable and necessary. It is my opinion that the symptoms and treatment beyond that date cannot be considered injuries f.om the motor vehicle accident, but were very likely due to his pre- existing degenerative arthritis and the aggravation that occurred following the fall in June of 1994. It is my opinion that the second EMG study by Dr. cho was clinically appropriate. with respect to the physical therapy services at the Trindle Rehabilitation Center, it is my opinion that with respect to the June of 1993 motor vehicle accident injuries the services provided were medically necessary and reasonable through 7/31/94. Because of the aggravating incident in June of 1994, it is my opinion that the additional treatment especially the pelvic traction and therapeutic exercises were due to a separate incident which in all medical probability aggravated the pre-existing conditions from the Nesmith, Joseph Page 5 June of 1993 accident and also from the underlying degenerative arthritis. with respect to Haximum Therapeutic Benefit of treatment, it is my opinion that the physical therapy services at the Trindle Rehabilitation Center were medically necessary and reasonable through 7/31/94 and that the services by Dr. Cho were medically reasonable and necessary through 9/15/94. For the reasons noted above, it is my opinion that treatment beyond these dates would not be reasonable or necessary for the motor vehicle accident injuries of 6/10/93. If I can be of any further assistance to you with respect to this file or if you have any questions regarding my report, please contact me at your convenience. Sincerely yours, ^ 1 e.....l. U e-:-c...-t~, AA.~][..6 /M~ A. H~~~ico, M.D. Independent Medical Consultants, Inc. DICT:klw .' BILLING OFFICE 51Zq E Irindle Road Mechdnlcsburg PA 1/0&& Phone": 117-79&-7935 fIN" :3 ,~107032 TO: JOE NESMITH JR q;:q FAIRGROUND AVE CARLISLE,PA 17013 I ACCOUNl IAMOUNT DUEIClOSE DAlEIPAGE 1------------------------------------ Inesmjo-011 36&.00 I 06/16/97 I 01 ------------------------------------- Please Make Check Payable 10. fRINDlE REHAB MEDICINE CENIER rhls account l~ now due. Pled&e send payment today. If this claIm has been submitted to your In~urance carrier, please contact them. DATE IDR.IPArIENTIPROC CDEI DESCRIPllON I DIAG 1 AMOUNT ---------------------------------------------------------------~._------------ 02/14/96Ipt 0<./14/961 pt 02/14/96 pt 02/14/96 pt 02/14/96 pt 02/14/96 pt 02/14/96 pt 02/1&/96 pt 02/1&/96 pt 02/1&/96 pt 02/19/96 pt 0<:/19/96 pt 02/19/96 pt 02/19/96 pt 02/19/96 pt 02/21/96 pt 0l/21/96 pt 02/21/96 pt 02/21/96 pt 0;:/21/96 pt 112/21/96IPt 02/22/96Ipt 02/22/961pt 0~/22/96Ipt Joe Joe Joe Joe ,Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Ne w971& Ne W97<:0 Ne Q0103 Ne Q0104 Ne 97032 Ne 99070 Ne 97010 Ne 97032 Ne 97124 Ne 97010 Ne w971& Ne W9720 Ne 97032 Ne 97124 Ne 97010 Ne u9710 Ne W9720 Nel97110 Ne 197032 Ne1971;:4 Nel97010 Nel97110 Ne 197032 Nel97010 IPhyslcal Therapy 2+ More Modal7242 lEach Additiona 1& Min To W97117242 IPI Eval. Medi~are,W/C,Auto - ~7242 IPT Eval. Medicare,W/C,Auto - 17242 IpI Eiectric Stlm,manuai Each 1/242 IElectrodes- Disposable \7242 PI Hot/Cold Packs 17242 PT Electric Stim,manual Each 17242 PT Massage 17242 PT Hot/Coid Pack~ 17242 Physical rher~py 2+ More Modal7242 Each Additlona 1& Mln To W9711724<: Pl Electric Stim,manual E~ch 17242 PT Ma"sage 17242 PI Hot/Cold Packs 17242 PhYGical Therapy 2+ More Modal7242 Each Additiona 1& Min Fo W97117242 Phy<.ical Therapy, InitIal {117242 PI Electric Stim,manuai Each 1/242 PT Massage 17242 PT flot/Cold Packs 17242 Phy<.ical Therapy, Initial (1\7242 PF Electric Stim,m~nudl Each 1/242 IPT Hot/Cold Packe 172q2 60.00 90.00 60.00 30.00 46.00 26.00 20.00 4&.00 3&.00 20.00 60.00 30.00 46.00 36.00 20.00 60.00 60.00 3&.00 4&.00 36.00 20.00 3&.0Il 45.00 20.00 ..------. ------------------------------------------------------------------- ACCOUNT NOICURRENI I 31-60 I 61-90 1 91-120 lOVER 1201 ___________________ ---------------------------------------1 ne~rnjo-01 I 0,001 0.001 0.001 0.001 365.001 I I I I I I ..---.------------------ EXHIBIT --------------------------- I ICONTINUED I c BIllING OFFICE ~12q E Irindle Road Mechanlcsburg rA 1/0&& Phone~. 717-79&-7D3~ ElN~ 23-2107032 TO. JOE NESMIIH JR q;:q FAIRGROUND AVE CARLISLE,PA 17013 I ACCOuNT IAMOUNI UU~ICL05E DAfElpAGE 1------------------------------------ Inesmjo-011 365.00 1 06/16/97 1 02 Please Make Check Payable To: TRINDLE REHAB MEDICINE CENTER This account is no~ due. Pledse send payment today. If thIs ciaim hds been submitted to your insurance carrier, pledse cont~ct them. DATE IDR.lpA1 IEN11PROC CDE 02/26/96Ipt IJoe 02/26/961 pt 1J0e 02/26/96Ipt IJoe 02/27/96Ipt IJoe 02/27/96Ipt IJoe 02/27/96Ipt IJoe 02/28/96Ipt IJoe 02/28/96Ipt 1J0e 02/28:96Ipt 1J0e 02/29/96\pt IJoe 02/29/96Ipt IJoe 02/29/96Ipt IJoe 03/04/96Ipt 1J0e 03/04/961 pt 1J0e 03/04/96Ipt IJoe 03/04/96\pt IJoe 03/04/96Ipt IJoe 03/06/961 pt 1J0e 03/06/961 pt 1 Joe 03/06/96Ipt 1J0e 03/06/96Ipt IJoe 03/06/96lpt IJoe 1l3/12/96lpt IJoe 03/12/96lpt 1J0e Ne19/110 Nel97032 Ne 97010 Ne 97110 Ne 97032 Ne 97010 Ne 97110 Ne 97032 Ne 97010 Ne 97110 Ne 97032 Ne 97010 Ne ~9715 Ne W9720 Ne 97110 Ne 97032 Ne 97010 Ne ~9715 NelW9720 Nel971lil Nel97032 Ne 197010 Ne 197110 Nel97032 DESCRIPTION I DIAG 1 AMOUNT Physical Therapy, Initial (1/7242 PT Electric Stlm,manual Each 172q2 pr Hot/Cold Packs 72q2 Physical Therapy, Initial (1 7242 Pf Electric Stim,manual Eac~ 7242 PT Hot/Cold Packs 7242 Physical Therapy, Initial (1 72q2 PT Electric Stim,manual Each 7242 P1 Hot/Cold Packs 72q2 Physicdl Therdpy, Initial (1 72q2 PT Electric Stim,manual Each 72q2 PT Hot/Cold Packs 7242 Physical Therapy 2+ More Moda 7242 Each Additiona 15 Min To W971 72q2 Physical Therapy, Initial (1 7242 PT Electric Stlm,manual Each 72q2 P r Hot/Cold Packs 7242 Physical Therapy 2+ More Modal72q2 Each Addltlona 15 Mln To W971'17242 Physical Therapy, Initial (1/72q2 P1 Electric Stirn,mdnudl Each 172q2 PT Hot/Cold Packs 17242 Physical rherdpy, InItIal (11/2q2 PT Electric Stim,mdnual Each 172q2 35.00 45.00 20.00 70.00 45.00 20.00 70.00 45.00 20.00 70.00 45.00 20.00 60.00 30.00 35.00 45.00 20.00 60.00 30.00 35.00 45.00 20.00 70.00 45.00 ----------------------------------------------------------------------------- 1 CONTINUED 1 ACCOUNt NOlcur-RENT 1 31-60 I 61-90 1 91-120 lOVER 1201 - ---------------------------------------------------------I n..mjo-01 1 0.001 0.001 0.001 0.001 365.001 1 I 1 I I I BILLING OFFICE 5124 E Trlndle Road Mechanlc.burg rA 110&& rhone~: 111-19&-191& I ACCOUNT IAMOUNT DUEICLOSE OATEIPAOE 1------------------------------------ Inesmjo-011 36S.00 I 06/16/91 I 03 ElN~ 23-210703<: TO: JOE NESMIIH JR 424 FAIRGROUNO AVE Please Make Check PaYdble To, CARLISLE,PA 17013 [RINDLE REHAB MEDICINE CENTER This dccount Is now due. rlease send payment today. If this claim has been &ubmittcd to your in~urarlce carrier. pleaco cuntd~t them. DATE IDR.IPATIEN1IPROC CDEI DESCRIPTION ---------------..---- --------------------------.------------------------------ I DIAG I AMOUNT 03/12/96Ipt 04/26/96 pt 04/26/96 pt 04/26/96 pt 04/26/96 pt 04/26/96 pt 07/29/96 07/29/96 08/01/96 08/01/96 08/08/96 pt 08/08/96 pt 08/08/96 pt 00/08/96 pt 08/08/96 pt 00/0!l/96 pt 0B/08/96 pt 08/08/96 08/08/96 08/08/90 08/08/961 06/08/961 08/08/961 06/09/961 Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Ne 97010 Ne Ne Ne Ne Ne IPT Hot/Cold Packs \Adjustment I Adjustment IAdjustment IAdjustment IAdjustment IAdj,PA Biue Shield IPlan Payment'2355742 IAdj:P~ Blue Shield IPlan Payment:236048S IAdjustment IAdjustment IAdjustment IAdjustment IAdjustment IAdjustment IAdjustment IAdjustment \Adj,PA Blue Shield IPlan Payment:2367851 IAdj:PA Blue ShIeld IAdjustment IPlan Payment:23678b2 IPlan Payment:2369270 17242 I I I I I Blue Shi\ I Blue Shil I I I I I I I \ Blue Shil Blue Shil I Blue Shi\ Blue Shil I I 20.00 150.00- 90.00- 120.00- 90.00- 90.00- 766.90- 196.00- 130.00- 66.00- 90.00 90.00 120.00 90.00 90.00 230.011 5.00 0.00 140.00- 32.00- 140.00- 0.00 12B.00- 12B.00- Ne Ne Ne Nel Nel Nel Nel I I I I I I I CON1INUEO ACCOUNT NO!CURRENT I 31-60 I 61-90 I 91-120 lOVER 1201 -----------------------------------------------------------1 ne5mjo-01 I 0.001 0.001 0.001 0,001 365.001 I I I I I I ------------------------------------------------------------------------------- BILLING OHICC 5124 Elrindle Road Mnchanicsburg PA 1/055 Pho"e": 717-795-7935 E IN" 23-2107032 TO: JOE NESMITH JR 4~4 FAIRGROUND AVE CARLISLE,PA 17013 1 ACCOUNI IAMOUNI DUEICLOSE DAIEIPAGE 1------------------------------------ Inesmjo-011 365.00 1 06/16/91 I 04 ------------------------------------- Plea~e Make Check Payable To: TRINDLE REHAB MEDICINE CENTER ThIs account is now due. Please send payment today. ,If tills claIm h.H been submItted to your insurance carrier, please contact thom. DATE IDR.IPATIENTIPROC CDEI DESCRIPTION 1 DIAG I AMOUNT ------------------------------------------------------------------------------ 0B/09/961 04/25/97Ipt 1 I 11/16/94Ipt 11/16/94Ipt 11/16/94 pt 11/16/94 pt 11/22/94 pt 11/22/94 pt 11/22/94 pt 11/22/94 pt 11/23/94 pt 11/23/94 pt 11/23/94 pt 11/23/94 pt 12/05/94 pt 12/05/94 pt 12/07/94 pt 12/07/94 pt 12/12/94 pt 12/12/94 pt 12/14/94 pt 12/14/94 pt Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe Joe 1 Nel 1 I Ne197110 Ne197032 Ne 97124 Ne 97010 Ne 97110 Ne 97032 Ne 97124 Ne 97010 Ne 97110 Ne 97032 Ne 97124 Ne 97010 Ne 97110 Ne 97012 Ne 97110 Ne 97012 Ne 97110 Ne 97012 Ne 97110 Ne 97012 Blue Shil I 1 1 Physical Therapy, Initial (117242 PT ElectrIc Stim,manual Each 17242 Pl Massage 17242 PT Hot/Cold Packs 17242 Physical Therapy, InItial (117242 PT TherapeutIc Exercise \7242 Pl Massage 17242 PT Hot/Cold Packs 17242 Physical Therapy, InitIal (117242 PT Therapeutic Exercise \7242 PT Massage 17242 PT Hot/Cold Packs 17242 PhysIcal Therapy, Initial (111242 PT TractIon, Mechanical 17242 Physical rherapy, Initial (1'1/242 PT Traction, Mechanical \7242 Physicai Iherapy, Initial (111242 PT r raction, Mechanicai 17242 Physical Therapy, Initiai (11'242 PT Traction, Mecha"ical 1/242 Adjustment Adjustment deductable vv At Carrier vv 141'-00- 611.00 111.1111 45.00 3S.1I11 20.00 711.1111 45.110 3S.1I11 211.110 711.1111 45.00 3S.1I11 211.1111 711.110 35.110 70.00 35.110 7'L00 3S.00 70.00 35.00 ---------------------------------------------------.-------------------------- ACCOUNT NOICUHRENI 1 31-60 pesmjo-Ol 1 1 0.001 I 0.001 I 61-90 I 91-120 lOVER 1201 ----------------------------1 0.001 0.001 365.001 I 1 1 ICONTINUED 1 ------------------------------------------------------------------------------- BILLING OFFICE b124 E Trindie Road Mech~nicsbur9 PA 1/055 Phone.: 717-795-7935 UN. 23-2107032 TO I JOE NESMITH JR 424 FAIRGROUND AVE CARLISLE,PA 17013 1 ACCOUNT IAMOUNT DUEICLOSE DATEIPAGE 1------------------------------------ Inesmjo-0LI 305,00 I 06/L6/97 I 05 ------------------------------------- Please M~ke Check Payable To: TRINDLE REHAB MEDICINE CENTER This account is now due, Please send payment today. If this ciaim has been submitted to your insurance carrier, please contact them. DATE IDR.IPAIIENIIPROC CDEI DESCRIPTION I DIAG 1 Arl0UNT -------------------------.-----------------------------------------.----------- L2/19/94Ipt IJoe 12/19/941 pt lJoe 12/2B/94Ipt IJoe 12/2B/94Ipt 1J0e 12/2B/94Ipt IJoe 12/29/94 pt IJoe 12/29/94 pt IJoe 12/29/94 pt IJoe 12/29/94 pt lJoe 01/04/95 pt IJoe 01/04/96 pt lJoe 01/05/9& pt 1J0e 01/06/96 pt lJoe 1 1 1 I I I 1 1 1 1 I 1 I 1 1 1 1 I 1 I 1 I 1 1 1 1 1 1 1 I 1 I 1 1 1 ----------------------------------------------------------- PAY THIS AMOUNT --) 1 166.00 I Ne 197110 Ne197012 Ne197110 Ne197110 Nelg7012 He197110 He 197110 Ne197010 Hel97012 He 97110 He 97012 He 97110 He 97012 Physical Therapy, Initial (117242 PT rraction, Mechanical 17242 Physical Therapy, InItial (117242 Physical Therapy 1 Area Each 17242 PT Traction, Mechanical 17242 Physical Therapy, InitIal (1\7242 Physical Therapy 1 Area Each 17242 PT Hot/Cold Packs 17242 PT TractIon, Mechanical 17242 Physical Therapy, Initial (117242 PT TractIon, Mechanical 17242 Phy~lcal Therapy, InitIal (117242 PT Traction, Mechanical 17242 1 I I I .1 1 1 1 1 1 1 ACCOUNT HolcURREHI 1 31-60 1 61-90 1 91-L20 lOVER 1201 --------------------------------------------------.---------1 nesmjo-0L 1 0.001 0.001 0.001 0.001 365.001 I I I 1 1 1 70.00 36.00 70.00 60.00 36.00 70.00 60.00 20.00 36.00 36.00 36.00 3&.00 36.00 ---.---------------.-.-----------.---------------------.-.---------------------------- 6ILLING OFfICE b124 East Irindle Road M~chdnlG5burg PA 11055 f' h 0 n c" : 7 17- 7 95 -793!> L IN" 23-2107032 TO: JOE NESMITH JR 424 FAIRGROUND AVE CAHLlSLE,PA 17013 I ACCOUNf IAMOUNT DUEICLOSE DAIEIPAGE 1------------ ----------------------- Ine6mjo-001 617,00 I 06/16/91 I 01 ----------- -------------------------- Plea6e Make Check Payabie 101 REHAB MEDICINE ASSOC,MECHBRG We flIed d ciaim to your In6urance carrier oyer 90 daY6 ago and to date haye not receiyed payment. As the insured, you dre responsIble for seeing this biil is paid. Piea6e pay this balance in full. Thank you. DATE IDR.IPATlEN1IPROC CDEI DESCRIPTION I DIAG I AMOUNT ----------------------------------------------------------------------------- 09/27/94Icho 11/30/94Icho 12/29/94Icho 01/17/951 cho 02/08/96Icho 03/08/9510ho 01/24/96Icho 02/07/96Icho 02/09/96 cho 02/29/96 cho 04/09/96 01'00 04/30/96 cho 05/14/96 oho 06/06/96 cho 07/05/96 cho 06/06/96 cho 06/06/96 08/06/96 08/1'0/96 00/21/96 08/21/96 09/11/96 09/11/96 Joe Joe Joe Joe Joe Joa Joe Joe Joe Joa Joe Joe Joe Joa Joe Joe I cholJoe I I I I Your 99213 99213 99213 99213 99214 99214 99214 99214 Ne Ne Ne Ne Ne Ne Ne Ne Ne Ne 99214 Ne 99214 Na 99213 Ne 99213 Nel99213 Nel99213 Ne199213 I I Nel09102 I I I I insurance lev L2, Subsequent 17244 IOV L2, Sub6equent 17244 IOV L2, Subsequent 1'244 IDV L2, subsequvnt 17244 lev L3, Subsequent 17244 lev L3, Subsequent 17244 IOV L3, Subsequent 17242 IOV L3, Subsequent 1723.4 IAdjustment I IOV L3, Subsequent 17242 lev L3, Subsequent 17244 lev L2, Subsequent 17244 IOV L2, Subsequent 17244 lov L2, Subsequent 17244 IOV L2, Subsequent 17244 lev L2, Subsaquent 17242 IAdj:PA Blue Shieid Biue erol IPlan Payment:2364887 I IMedicaI Records (initial chg)17242 IAdj:PA Blue Shield Blue eral Iplan Paymcnt:2383457 I IPlan Payment:2405355 I IAdj:PA Blue Shield Blue ~hil company applied this balance to your I I I I I I I I 1 I I I 1 I I I 1 I 1 I I 1 1 55.1'11'1- DEDUCTIBLE. 40.00 40.00 40.00 40.00 60.00 60.00 80.00 80.0~ 36.00- 80.00 B0.00 60.00 60.00 50.00 50.00 50.00 35.1'11'1- 36.1'11'1- 45.00 31'1.1'11'1- 96.1'11'1- 11'11'1.1'11'1- -------------------------------------------------------------------------------- ACCOUNI NoleUHRENI I 31-60 I 61-90 I 91-120 lOVER 1201 __________________________________.___________________------1 'nesmjo-00 I 1'1.001 24.1'101 45.001 40.001 508.001 1 1 I 1 I I leONTINUED I ------------------------------------------------------------------------------- BILLING OFFICE 5124 East lrindie Road Mechdnicsburg PA 1/055 Phone~: 717-795-7935 ElN~ 23-2107032 TO, JOE NESMITH JR 424 FAIRGROUND AVE CARLISLE.PA 17~13 I ACCOUNr IAMOUNT OUEICLOSE OAIEIPAGE 1------------------------------------ Inesmjo-001 61/.00 I 06/16/97 I 02 ------------------------------------- Piedse Mdke Check Pdyabie To, REHAB MEOICINE ASSOC,MECHBRG We flied a cia{m to your insurance cdrrier over 90 ddYS ago and to ddte have not received pdyment. As Lhe inr.ured. you are recporlsible for seeing this bill is paid. Please PdY this baldnce in full. !hank you. DATE IDR.IPATlENrlPROC CDEI DESCRIPTION I OIAG I AMOUNT ----------------------------------------------------------------------------- 02/11/97 ~3/13/97 ~3/25/97 04/16/97 ~4/16/97 ~&/01/97 ~&/01/97 ~9/17/96 1~/IB/96 10/1B/96 1~/IB/96 11/21/96 11/21/96 12/03/96 12/17/96 12/17/9b 05/14/97 OS/22/97 06/10/91 ~b/l~/97 cholJoe Nel99213 1 I Your lnr.urdnce comp cholJoe Nel99214 Your insurdnce comp cholJoe Nel99213 I I I I 1 1 1 1 cholJoe Nel99213 cholJoe Ne\99213 I I 1 1 cholJoe Ne 99213 I I cholJoe Ne 99213 cholJoe Ne 09102 I I I OV L2. Subsequent 11242 50.00 Adj:PA Blue Shield I I 10.11- ny dpplied Lhis bdlance to your DEOUCTIBLE. OV L3. Subsequent 17231 I B0.00 ny applied this balance to your DEDUCTIBLE. OV L2. Subsequent 17210 1 50.00 Adjustment I I 35.11- Plan Payment:2725055 1 I 16.11- Adj :Write-off Blue Shi 1 I 10.li- vv At Carrier vv I 1 OV L2. Subsequent 17222 I OV L2. Subsequent 17244 1 AdJ :PA Blue Shield Blue Crol I Pldn Payment:2456236 1 I Adj:PA Blue Shield Blue Crol Plan Payment:2504441 1 OV L2. Subsequent 17242 Plan Payment:253Bl91 I Adjustment Blue Shil OV L2. Subsequent 17242 Medical Records (initial Chgll1242 req by atty Jennifer deit~~m II Pldn Payment: 27B1535,dAatiL Q4; Adj :~Jri te-off Blue.,hi 1 50.00 50.00 11.11- 32.11- 11.11- 32.11- &0.00 32.11- 10.11- &0.00 200.00 32.11- 11.11- ---------------------------------------------------------------.---- --------- PAY fillS AMOUNl --) 617.00 I\CCOUNI NolCURRENT I 31-60 1 61-90 I 91-UO lOVER UOI ______________________________________________________-----1 ne';lIIjo-OO 1 0.001 24.001 4&.001 40.001 &08,001 1 1 I I 1 I ------------------ -------------------------------------.-------------------------- () ,,") (') ~..~ ::.41 >"1 ::;"". ,;",) -r, \.~ ",., -j j=!J fili, ::lJ :-::" tt.> ,n, It? I'>, ..::> .) I eLf ',C) :r.~ ":.fl :'::c., ~ :"1 .:(") , . ~ , " :)fll '. ~. ~., ,'..- I ,. .:" :.--! ~...l ,::> "' MdJRAW, IIAH olllHTCIIMAN .. l.ibaty Avenue Carti~.. fA .,Oll 1717l2~9-1300 1^"ornC)'s fur PlalnlilTl IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY. PENNSYLVANIA JOSEPH NESMITH. aIkIa JOE NESMITH. JR.. Plaintiff : Civil Action - Law : No,: 97-5491 vs, : PRAECIPE TO SATISFY : JUDGEMENT NATIONWIDE MUTUAL INSURANCE COMPANY. Defendant TO: Prothonotary Please mark the default judgment in the above-captioned matter fully satisfied. and costs paid. Respectfully Submitted. McGRAW. HAlT & DEITCHMAN By: ennifer C. Deitchman Pa, ID II 72719 4 Liberty Avenue Carlisle. PA 17013 (717) 249-4500 Date: 11125/98