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Home My WebLink About98-00895 " u ~ t ~ , ~ . II1d ~ " ':'\s .. 3 .~ {:: ~ "1 ) 3""" ~( ~ ~ -.... t ~ - . - ') '- v, u- D.o a... ~ , ~ 5. On May 5, 1996, Plaintiff Debra K. Keppleywas the driver of a 1996 Toyota Tercel travelling south on Interstate 81, 6, At that time and place, Plaintiff Debra K, Keppley, was violently struck by a 1994 Peterbuilt tractor-trailer dr.iven by April H, Dewitt, causing Debra Keppley's car to spiJ'l out of control, spinning two full rotations as it crossed the left southbound lane before striking a guardrail and beillg propelled back acrOflS the highway, and coming to rest on the right shoulder, 7, As a result of the aforesaid accident, Plaintiff Debra K, Keppley sustained painful and severe injuries, which include, but are not limited to a large disk extrusion at the C5-6 level, impingement of the cervical cord at the C5-6 level, and numbness in the hands, 8, Plaint iff Debra Keppley has been required to undergo extensive medical treatment including a painful anterior cervical discectomy and fusion in an effort to restore herself to health, 9, Plaintiff Debra K, Keppley cont!,nues to suffer from injuries arising from the accident for which she has and will need medical treatment in the future, 10, Defendant Nationwide initially paid for Plaintiff Debra K, Keppley's treatment following the accident, 11, Defendant Nationwide has denied continued coverage for Plaintiff Debra K. Keppley's accident-related medical bills and has refused to pay certain past and continuing accident-related medical bills through the present. 2 12, All of Plaintiff Debra K, Keppley's medical bills were incurred for reasonable and necessary medical and rehabilitative services for the injuries which she sustained in the May 5, 1996 accident. 13, Copies of Plaintiff Debra K. Keppley's accident-related medical bills and medical records have been sent directly to Defendant Nationwide by Plaintiff Debra K, Keppley, her physicians or her attorney. 14, Said physicians' records provide that plaintiff Debra K. Keppley's injuries are directly related to the trauma she sustained in the May 5, 1996 moGor vehicle accident, and for which she has been receiving continued care and for which Defendant did pay for her initial treatment 15, Defendant Nationwide requested a records review of Plaintiff Debra K, Keppley's accident-related medical treatment, 16, The records review was purportedly conducted to determine whether Plaintiff's treatment was causally related to the accident- related injuries sustained by Plaintiff Debra K, Keppley, 17, Plaintiff Debra K, Keppley maintains that Defendant Nationwide had no proper basis for requesting the records review because Defendant was provided with complete copies of records and reports in support of the bills submitted by Plaintiff Debra K, Keppley's treating healthcare providers for medical treatment relating to the accident. 18. Plaintiff Debra K, Keppley 3 maintains that Defendant Nationwide did not need to request records review to determine whether Plaintiff Debra K. Keppley's treatment was causally related to the accident-related injuries from the time of the accident for which Defendant Nationwide had previously been paying and sufficient documentation had been provided to Defendant Nationwide, 19, Plaintiff Debra K, Keppley based upon information and belief, believes that Defendant Nationwide conducts medical reviews of treatment routinely and without any proper basis, 20, Plaintiff Debra K, Keppley maintains Defendant Nationwide did not request Debra K, Keppley to be examined as part of the medical review and that the reviewing doctor only had a limited number of medical records to complete his review, 21, Plaintiff Debra K, Keppley alleges that Defendant Nationwide did not make a fair and impartial review but rather sought a review from a physician who regularly conducts records and peer reviews for Nationwide, and who Nationwide knew would more than likely find in its favor, 22, Plaintiff Debra K, Keppley further alleges that she had to engage counsel, and counsel has had to expend considerable time in research, correspondence, preparation, etc, To date, counsel has also incurred expenses in obtaining Plaintiff I s medical records and bills, Counsel will have to expend additional time and expense in the future in an attempt to obtain recovery for the medical bills as provided under the Pennsylvania Motor Vehicle Financial Responsibility Law, 4 23. Defendant Nationwide has refused to pay Plaintiff Debra K, Keppley's medical care as required by its agreelT\ents, its insurance contract, and as required by Pennsylvania Motor Vehicle Financial Responsibility Law, 75 Pa,C,S,A, ~ 1701 et seq, COUNT I 24. Paragraphs 1 through 23 of Plaintiff's Complaint are incorporated herein by reference, 25, Defendant Nationwide has refused to pay for Plaintiff Debra K, Keppley's additional medical treatment as required by its po1:l cy , 26, Defendant Nationwide has breached its contract with Plaintiff Debra K, Keppley, to pay all accident -related medical bills in accordance with the terms and provisions of the aforesaid automobile insurance policy whereby Plaintiff Debra K, Keppley's, first-party medical coverage provided for $5,000 in medical coverage, 27, Because Defendant Nationwide's failure to pay Plaintiff Debra K, Keppley's medical bills is without reasonable foundation and because Defendant acted in an unreasonable manner, Plaintiff Debra K. Keppley is entitled to recover her attorney's fees, costs, and interest pursuant to 75 Pa.C.S,A. ~ 1716 and ~ 1798. 28. Defendant Nationwide's conduct in denying first-party benefits has been wanton, and therefore, Plaintiff Debt'a K, Keppley is entitled to treble damages and interest, 75 Pa.C.S,A. ~ 5 "- co ~ i"r~ c:: '-,-.' <( ~~-L~5 1--: .. (" .:J 11J :;.' (')',' :!t: (.) " .~;. ( " ~.". ~'l' ~:i !:I.. ') ~'''i ii" -. '., I,'. <" :"u'r/? (-0" I ,1,,_ .LiLt ::"ldj --"I' >- n:::'l ....j: ;PI,L I~ ..t. , 1.1.. en "5 C) C'\ ()