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4, On or about December 17. 191)7, Plaintifl; Youssef Bounader. was slopped at a red
light on Route 22, Harrisburg, Dauphin County, Pennsylvania, when a vehicle owned and operated
by Mildred Yezdimir struck the rear of Plaintifl's vehicle. As a result of this collision. Plaintifl'
sustained extensive and severe personal injuries.
5, On or about February la, 1997, Plaintitl's wife, Octavy Bounader, had purchased a
policy of motor vehicle insurance with the Defendant insurance company through its authorized
agent, Shiner Insurance Agency, at 100 I S, Market SI., Mechanicsburg, Cumberland County, I' A
17055, Said policy was in full force and ell'ect on December 17, 1997, the date of the collision,
6, Pursuant to the terms and conditions of said policy with Defendant, Progressive
Insurance Co" Plaintiff, Youssef Bounader, was an insured, In addition, Plaintill'and his wife had
paid an additional policy premium to obtain $100,000 in first party medical loss benefits in accordance
with the Pennsylvania Motor Vehicle Financial Responsibility Law, P,S, * 1701, et gm, as amended,
7, As a result of the collision, Plaintiff. Youssef Bounader. sustained serious bodily
injuries, including, but not limited to, cervical. thoracic and lumbosacral strains; sacroiliac syndrome;
myofascial pain; and persistent lower extremity radicular symptoms, compatible with a right L5-S I
herniated disk.
8. As a fun her result of tl1(~ aforementioned collision, Plaintitr has been compelled to
receive and undergo extensi\C medical .mention and care and to expend large sums of money and/or
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10, It is averred that all medical bills have been, and continue to be, f.1ir, reasonable, and
medically necessary, and that all treatment has been, and continues to be. related to the
aforementioned incident,
II, From the commencement of treatment, and at various times thereafter. Plaintiff;
Youssef Bounader, and his medical care providers have requested that Defendant pay the
aforementioned medical bills as they have been accumulating,
12, Plaintitrs credit history will be adversely affected as long as Defendant continues to
deny responsibility for payment of reasonable, necessary, and related medical treatment.
13, Plaintitl's third-party personal injury claim will be adversely affected as long as
Defendant continues to deny responsibility for payment of reasonable, necessary, and related medical
treatment.
14, Defendant, Progressive Insurance Company. pursuant to 91797(b)(I) of the
Pennsylvania Motor Vehicle Financial Responsibility Law, as amended, has contracted with a peer
review organization (PRO) for the alleged purpose of confirming that said treatment conformed to
professional standards of performance and medical necessity, The name and address of said PRO is:
Claims Review Associates, 660 American Avenue. Suite 103, King of Prussia, Pennsylvania
(hereinafler "CRA"),
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19, Pursuantto31 Pa,Code ~69.52(c) thc PRO shall requcst in writing, fromthc providers
undcr rcview. all records and documents neccssal)' to undcrtakc its review,
20, Claims Rcvicw Associates failcd to forward a written requcst for all rclcvant records
and documents to any of the providcrs being rcviewed,
21, Pursuant to 31 Pa,Code ~ 69.52(c), the PRO shall afford the providcrs an opportunity
to discuss the case with thc rcviewer and to submit any information to the reviewer.
22, Claims Revicw Associates did not afford the providers. and particularly Dr. Stuart
Hartman and Kathy Stcwart. L.P,T" the opportunity to discuss thc case with thc revicwcr or to
submit information to the revicwer,
23, On Junc 19, 1998, Dr. Dane K. Wukich, an 0I1hopedic surgcon whosc practicc is
"limited to orthopcdic surgcry," completed his peer revicw of thc trcatmcnt providcd to Plaintiff,
Y ousscf Bounadcr, A copy of thc pecr Tcview report is attachcd hercto, made a part hereof and
marked, "Exhibit c."
24, At the time of his review. the records Dr. Wukich relied on were limited to thc
following:
(I) Pinnacle Health. Polyclinic Hospilal Emergency Room. dated Dcccmber 17. 1997;
(2) A bill for a chcst X-ray, dated January 28. 1998;
(3) The rccords ofBrucc Goodman, M.D. from January 5, 1998 through April 14. 1998;
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(4) Physical therapy records from HealthSouth dated January 5, 1998 through
February 5, 1998;
(5) Records of Rehab Works from January 23. 1998 through February 25. 1998;
(6) Records ofI-/artman Rehab, dated March 19, 1998; and
(7) A bill from Dr, Eugene York, dated March 13, 1998,
25, On or about May 21, 1998, Dr, Hartman referred Plaintiff, YoussefBounader, for
physical therapy,
26, On or about May 27, 1998, Plaintiff, Youssef Bounader, began physical therapy
treatment at Alternative Physical Therapy, under the direction of Kathy Stewart, L.P, T,. pursuant to
Dr. Hartman's referral.
27, In his peer review report (See Exhibit C,), Dr, Wukich reached the following
conclusions:
(I) The treatment rendered to this examinee was appropriate and medically necessary;
(2) The referrals to HealthSouth and Rehab Works were appropriate;
(3) The diagnostic testing was appropriate;
(4) The recommendation for physical therapy was appropriate;
(5) The length of treatment is appropriate;
(6) The time intelval between injury and treatment is usual and Customary;
(7) Typically. patients reach maximum medical improvement within six months after a
soil tissue injury; and
(8) If the cervical MRl study does not show any significant structural findings, maximum
medical improvement would be expected to be reached on or about May J 7, 1998,
28, Pursuant to 31 Pa. Code * 69,52(d), a PRO's initial determination shall be completed
within 30 days aHer receipt ofrequesled information,
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29, As averred above, the PRO in this case had received "the necessary documentation"
on or before April I, 1998, The PRO's initial determination, however, was not completed until June
19,1998, well in excess of30 days,
30, Pursuant to 31 Pa, Code * 69,52(e), all parties shall be notified of their right to request
a reconsideration and the process and location for filing a request for reconsideration,
31, Not all providers were notified of their right to request a reconsideration. Those
providers that were notified were not advised oflhe process and location for tiling a reconsideration,
See altached letter from Defendant, Progressive Insurance Company, dated June 29. 1998, Said
letter is attached hereto, made a part hereof, and marked "Exhibit 0,"
32, Pursuant to 31 Pa, Code * 69,52(1). a PRO's initial determination resulting in denial
ofa provider's claim. in whole or in part, shall be effected by a licensed practitioner of like specialty.
33, The reviewing physician is an orthopedic surgeon who limits his practice to orthopedic
surgery only, As a result of his review. medical bills from. inter alia, Dr. Stuart Hartman and Kathy
Stewart, L.PT were denied, Dr. Hartman is a physiatrist and Ms, Stewart is a physical therapist.
34. Pursuant to 75 Pa.C.SA * 1797(b) and 31 Pa. Code * 69,52(g). there must be a
determination of "nol medically necessary" for there 10 be an adequate basis to deny payment.
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35, Plaintiff believes, and thereforc avcrs. that thcre was no reasonable basis to deny
payments based on the June 19. 1998, pccr revicw report, bccause Dr, Wukich makes no conclusions
regarding the medical necessity of treatment af\cr May 17, 1998,
36, Pursuant to 31 Pa,Code * 69,52(e}, a PRO's written analysis shall include specific
reasons for its decision,
37, Plaintiff believes, and therefore avers, that Dr. Wukich did not include spccific reasons
for his opinion in the June 19, 1998, report.
38, Plaintiff believes, and therefore avers, that there was no reasonable basis to deny
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payments because Dr. Wukich's reports relied upon blanket characterizations of accepted procedure
without any physical examination ofYoussefBounader. The peer review did not consider Plaintitrs
prior health, specific injury, mechanism of injury, or his current medical condition before reaching its
conclusion,
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39, Plaintiff further avers that there was no reasonable basis to deny paymcnts based on
the June 19. 1998, peer review report because Dr. Wukich did not pe.rform a detailed analysis of the
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case and overlooked specific findings.
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COUNT"
BAD FAITH
47, Paragraphs I through 46. ubove, arc incorporated herein as though fully set forth
allenglh,
48, On or about February 7, 1990, the Governor of the Commonwealth of
Pennsylvania signed into law 42 P,S, ~8371, effective July I, 1990, titled, "Actions on Insurance
Policies," which provides a privule cause of action for bad f.1ith ugainst insurance companies as
follows:
In an action arising under an insurance policy, if the court
finds that the insurer has act cd in bad faith towurd the insured, the
court may take ull of the following actions:
(I) Award interest on the amount of the claim from the
date the claim wus made by the insured in an amount
equal to the prime rate of interest plus 3%;
(2) Award Jlunitive damages aguinst the insurer;
(3) Assess court costs and attorney fees against the insurer.
49, All treatment was provided to Plaintiff after the effective date of the ubove Statute
and the alleged bad faith occurred after the el1'cctivc datc of the Statute.
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(a) Representing that the Plaintitl: Youssef Bounader, would be covered by the lull
amount of the medical benefits purchased under the above-referenced policy,
when, in fact, said promise was wholly illusory;
(b) Purporting to offer a specified amount of medical coverage, when, in fact,
defendant had no intention of providing coverage to said extent;
(c) Charging a premium, based on a specified amount of medical benetits, when
in fact, Defendant purposely avoided fulfilling its contract to provide said amount
of benefits;
(d) Denying Plaintitf, Youssef Bounader, medical benefits andlor payment of medical
benefits without a reasonable basis;
(e) Refusing to pay the Plaintiff's claim without conducting a reasonable investigation
based upon all available information;
(f) In failing to use Claims Review Associates to evaluate the reasonableness and
necessity of medical treatment, but, rather, in using said PRO in form only as a
pretext for denying Plaintiff's first-party claim;
(g) In employing Claims Review Associates due to said PRO's financial interest in
providing Defendants with a biased report;
(h) Not attempting, in good faith, to etTectuate prompt, fair, and equitable
coverage of claims, once lhe Defendant's responsibility under its policy of
insurance had become reasonably clear;
(i) Failing to evaluate and determine Plaintilrs entitlement for treatment rendered,
based upon the terms of the policy providing co\'erage to Plaintitl: Youssef
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BOllnadcr, compclling thc Plaintilrto institute litigation to recover amounts due
undcr t hc applicablc insurancc policy provided by the defendant;
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By intcntionally ignoring the authorized peer review process of the Act 6
IImclHlntcnts to the Motor Vehicle Finandal Responsibility Law;
(k) By rcferring all bills, incurred by Progressive policyholders who have purchased
cxtcnsivc first-party medical benefits like Plaintiff's policy of$IOO,OOO in medical
hcnclits in thc case at bar, to PROs;
(I) By allowing a person unfamiliar with the peer review procedures, standards
IInd practiccs to determine that the peer review was necessal)', in violation of
31 Pa, Code *69.52(a),
\VB EREfiORE, Plaintiff demands judgment in his favor in an amount in excess of
twcnty.livc thousand dollars ($25,000,00), induding interest, punitive damages, costs, and
attorncy fces,
COUNT IJJ
WANTON CONDUCT
55. I'aragraphs I through 54, above, are incorporated herein as though fully set forth at
Icngth.
56. Dcfcndant's course of conduct in rctusing to pay the balance due to Plaintin's medical
providcrs undcr the terms and conditions ofthc applicable insurance contract, in not adhering to the
rcquircmcnts as sct f(mh in law. and ill acquiescing in thc PRO's failure to do so, has riscn to the level
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VERIFICATION
THE UNDERSIGNED hereby verifies that the statements in the foregoing
document are based on infonnation that was gathered by counsel in preparation of this
lawsuit. The language of the above-named document is of counsel and /Jot illY own, I
have read the said document and, to the extent that it is based on infonnation that I gave
to counsel. it is true and correct to the best of my knowledge, infonnation and belief, To
the extent that the contents of the said document is that of counsel, I have relied upon
my counsel in preparing this Veritication,
THE lJNDERSIGNED also understands that the statements therein are made
subject to the penalties of 18 Pa,R,C,P, 2252(d) c.s, Section 4904, relating to unsworn
falsification to authorities,
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""A THV STEWART
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KATHERINE H,. STEWART \,
I'lIYS1Clll, TIlEIW'ISr
5418 Locust I,ana
I~RISBURG, P^ 17109
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PHYSiCAl 1l1C1W'IST
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HARTMAN REHAB ASSOC Pelle 1
Patient Ledger
03/25/99
Chart Date prov Loc Billing Diagnosis Procedure Amount
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BOU64E>8-00 ( YOUSSEF BOlJNADER, Home (717 )6S1-090S)
( Insurance 10: 971062007 CLN)
03/19/98 SAH 3 76 723.4 99245 190 ,00 .',
08/04/96 SAH 76 PMVP -143.64
08/04/96 SAH 76 AMVA -46,36
( Insurance 1 bi lied 03125/98 )
04/23/98 SAH 3 608 847.0 99214 8" ,00
(J8/04/98 SAH 608 PMVA -4\ ,48
08/04/'i8 SAH 6013 AMVA -43.52
( I nsur,~nce 1 bi.lled 04n7/98 )
05121/98 SAH 3 1111 847.0 99214 85.00
( Insurance 1 billed OS/28/98 )
07/30/90 SAH 3 2186 847.0 20550 130 .00
0'1/30/98 SAH 3 2186 847,0 99214 85,00
11/11/98 SAH 2186 CMDt~ 0,00
11111/98 SAH 2186 CAL.L. 0.00
( Patient billed 11/12198)
( Insurance 1 bill ed 08/05/98)
09/08/98 SAH 3 2761 847,0 99214 85,00
( Insurance 1 bill ed 09/15/98 )
10/15/98 5AII 3 3312 729.1 64450 120.00
( Insu,'ance 1 billed 10/20/98 )
11/24/98 SAH 3 3910 724.2- 99214 85.00
01125/99 SAH 3910 INSRJ 0.00
( Patient bill ad 01/25/99 )
( Insurance 1 bill ed 12/01198 )
01/26/99 SAH 3 4746 724,2 99213 60.00
03/09/99 SAH 4746 . PEER 0.00
(Insuranc'? 1 billed 01127/99)
02/12/99 SAH 3 5033 NDRPT 125,00
02/25/99 SAH 5033 PMED -125,00
( I nsur Ai n(';t:a 1 billed 02/16/99 )
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Patient Debits,.,.
Patient Credits...
1050.00
-400.00
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Balanc." . , . . . . . . . .
650.00
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sTUART A HNHMAN 00
Provider Debits".
Provider Credits.,
10~,O .00
-400,00
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Provider Balance..
650,00
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Plooao ontor addrestJ or lnauranco chungos on back IInd chock this box 0
! I SEPAYTHl9Al1OUIIT oli~
HOSPITALS CONTINUED 12/~~
1 7 105 . AMOUNT PAID ~
- WE ACCEPT VISA,M/C ~
DISCOVER & AMER,EXP
ACCOUNT NUMBER ANO NAME
--980348430 ~. -
BOUNADER .YOUSSEF
. ..i.c:>R INFORMAnON ON ACCDUNT pU!Asii.CAL.L
(717)657-7443
ROBIN ~
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PINNACLE HEAl.TH
BOX 2353
HARRISBURG. PA
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PINNACLE HEALTH Hasp
P.o. BOX :2:353
HARRISBURG. PA 17105
ADM aT:
DSH DT:
SB:
HOSP SVC:
050198
"'NONE...
HOoaD
POS
724.2
980348438
YOUSSEF BOUNADER
4308 KOTA AVE
HARRISBURG PA 17110-9595
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PINNACLE HEALTH
P,O, BOX ::>,353
HARRISBURG. PA
ploaso dotach along dotted line and roturn this portion with your paymont:-1
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HOSPITALS
17105
QUESTIONS? PI....C"u: (717)657-7443
ACCOUNT BALANCE3 ESTlMATEO INSU.RANCE OUE
1. 116.00 .00
. -
TRANS DATE
AtwllntNumb.
r,tillllNlml
S~ceSI"1
StlltmIllIO'I.
hgt 3
980348438
BOUNADER .YOUSSEF
05/0 1/9a Swvl~End
11/1 B /98 lnlStll."WltOltl
10/29/98
Conta("t: ROBIN
TOTAL PA11ENT CREOITS
PLEASE PAY TIllS A'MOUNT
1.116.00 _J
OESCRIPTlO~
AMOUNT "'.--1
90o.00l
.00 I
.00
,00 I
. ,00
10B.00 I
.00
.00
.00
.00 I
.00 I
.00 I
.00 ,
.00 I
.00 I
10B.00 I
108.00 I
10B.OQ-
.00
,00
.00
PREVIOUS BALANCE
05/15/9B 1 MOBILIZATION
05/1B/98 1 MOIST PACKS
05/'8/98 1 PELVIC TRACTION
05/1B/e8 1 ELEC STIMULATION
05/18/98 3 OP SUPV PT 15
OS/18/98 1 00
05/18/98 1 DOC/CHT REV 5M PT
OS/10/9B 1 MOBILIZATION
OS/20/98 1 MOIST PACKS
OS/20/98 1 MOIST PACKS
05/20/98 1 ELEC STIMULATION
OS/20/98 1 ELEC s'rIMULATION
OS/20/98 1 EXERCISE
OS/20/98 1 EXERCISE
OS/20/98 3 OP SUPV PT 1S
OS/20/98 3 OP SUPV PT 15
I OS/20/90 3 OP SUPV PT 15
OS/20/9tj 1 00
OS/20/98 1 00
1__ 05l~0/~8 ._..~~.O~~,RE~.!i!".
H 0 0 PO MB
YOUR ACCOUNT IS PAST DUE!
THE ABOVE NUMBER.
X61 AUTO - PROGRE
FeES PT TYPE=L
00000
97010
97012
97118
97110
00000
00000
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97010
97010
97110
97118
97110
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Accourn BALAtJCE
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PLEASE PAY IMMEDIATELY
CONTINUED
OR CALL
.00
Until your in~uranco hilS p.id,lho PLEASE PAY THIS AMOUNl uprosonls the bat.nCI you ow..
An balanco unpaid bV your in:surance wilt be due from you... Thank you.
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PINNACLE H"-ALTH
BOX 2353
HARRISBURG. PA
~GO oolor nddroG3 or lnsuronco changos on back and chock thin box 0 I
HOSPI TALS 1_~~~~~~H~~:M~i!N~E~~~~~;~8 '1
17105 ___AM~UNT~ID .. J_.____________
WE ACCEPT VISA.M/C
DISCOVER 8 AMER.EXP
ACCOUNT NUMBER AND NAME
980348438
BOUNAOER .YOUSSEF
FOR INFORMATlON ON ACCOUNT PLEASE CALL
(717)657-7443
ROBIN
STATEMEII!T:OF;-ACC9 !')IT
I
PINNACLE HEALTH HaSP
P.O.. BOX 2353
HARRISBURG, PA 17105
r1~~-g~ ~ ~Eg~~-!]
: HaSP SVC: pas
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---
980348438
YOUSSEF BOUNADER
4308 KOTA AVE
HARRISBURG PA 17110-9595
_ _ _ _ _ _ _ _ _ _ _ _ _CP~9~S~ ~O~II:~ ~o~~ ~O~O_d ~i~O .:'~d !O_tU!"_ t~i~ ~_o~i~~.w..it~ ~o~r_p~Y~,~~t~_ _ . _ _ _ _ _ _
fllg' :2
PINNACLE HEALTH HOSPITALS
P.O. BOX :2353
HARRISBURG. PA 17105
980348438
BOUNADER .YOUSSEF
05/01/9B S.n1cIEnd
11/18/sa lnlSlltemtfllDm
10/29/98
AccounlHumb"
P,UtnlNlIIll
ServlCllSllfl
SlIl11t1lIWlIDII.
QU[STlONS? PI.... Call: (717)657-7443
ACCOUNT BALA~ ESTlMATED"isURANCE DUE
1. 11~~ .00
Con1(Jct: ROB I N
TOTALPATlENT.C~~~':_.~
-_._---------+_.---_._~---- -----..-----
TRAIlS OA TE OESCRIPTlON AMOllNT
._--~_. -----
PREVIOUS BALANCE 540.00
05/0B/9B 1 MOBILIZATION 00000 .00
05/11/9B 1 ELEC STIMULATION 97118 ,00
05/11/9B 1 EXERCISE 97110 .00
05/11/9B 4 OP SUPV PT 15 97110 144.00
05/11/9B 1 00 00000 ,00
05/11/9B 1 OOC/CHT REV 5M PT 00000 .00
05/11/9B 1 MOBJ:LIZATION 00000 .00
05/13/9B 1 MOXST PACKS 97010 .00
05/13/9B 1 PELVIC TRACTION 9701:2 .00
05/13/9B 1 ELEC STIMULATION 97118 :00
05/13/9B I 3 OP SUPV PT 15 97110 108.00
05/13/9B 1 00 00000 .00
05/13/9B 1 OOC/CHT REV 5M PT 00000 .00
05/13/9B ; MOeILlZATlON 00000 .00
05/15/9B I 1 MOIST PACKS 97010 ,00
05/15/9B 1 PELVIC TRACTION 97012- .00 'I
05/15/98 1 ELEC STIMULATION 97118 .00
05/15/9B I 3 01> $UPV PT 15 97110 108.00
05/15/9B 1 00 00000 .00 , ~
05/15/9B J 1 OOC/CHT REV 5M PT 00000 .00 I I
.-.--.----.-.--....-....-- .... ..-..--.----T---- --- -- - -- ----.. ---r-' -. --I
H 0 0 PO MB ACCOUNT BALANCE CONTIfroJUED
1.._._...___........ ..n_._. .._ ...__..._. _
YOUR ACCOUNT IS PAST DUEl PLEASE PAY IMMEDIATELY OR CALL
THE ABOVE NUMBER.
XBl AUTO - PROGRE .00
FCES PT TYPEal..
L___.
. . . . .. .
Unltl \,our lIlsuranco h35 p:l:ld. t1lCl ru::.ASE PAY ll115 AMOUrH rt>pto~onts tho balanco you owo.
__.__ __ Any bal.1n~~npald hv }'our m!'.utanC(l will bo duo h.~~!.'y"~?u." Thank you.
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~...
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DATE Of DILL
DATE Of
PRtv. BILL
PI~ACLE HL TH HOSP~' "\ c'.
BCt ,2353 Do3'\.u\~) "
HARRISBURG, PA '
717 230-3717 DSS
FEI 251778644
1""'1'" I
HCI
TYPE OF
BILL
2
03/25/99
110sr. NO,
3 C067
'18AU D D
'A L
, BOUNAD ER
GUARPH
PATIENT NAME PATIENl NUMIlEfl \5C,.. AC;! ADMISSION DATE DISCtlf.RGE OAT[ DMS
YOUSSEF---- -990229620Tj., -33-.02/15/99 -------
717 651-0905
'.O.B. INSURAIiCE COMP;.!>" ';:.M[
GROUP f.uMijt!,
roucv lilJM6ER
AND
YOUSSEF BOUNADER
4308 KOTA AVE
HARRISBURG PA,17110
1 HEALTH ASSURANCE
1 AUTO A-Z
21058121800
GUARANTOR
.
",
HARTMAN STUART A
I'MOU" OF IS
THIS PORTION WITH YOUR PAYMENT, PAYM'"
-5ffivrcf ----rOfAl"--r Esr.-CO-;[RAGt~ ~t.;r~co;ERill-' --(5t"c-o~R:\G[ E,,',;. -ccoo.~'~~~A~G,i."~'r'-". ',P,':~10""'YT'-
CODE CHARGES INS. CO. hO. 1 IllS. ce. NO.2 INS. CO, IiO. J "..,. M ..
DETAIL OF CURRENT CHARGES, PAYMENTS AND ADJUSTMENTS
,2/22 1100045 001 127,25 127.25 127.25 127,25-
THER PEUTIC ACT 60 MINOOOOO
,2/22 1100047 001 31,75 31,75 31.75 31,75-
WORK RELATED MEDICAL 099456
12/22 1100048 001 191.00 191.00 191.00 191,00-
MUSCLE TEST RANGE OF M95831
12/22 1100049 001 127.25 127.25 127.25 127.25-
BIOFEEDBACK TRAINING 690900
12/22 1100050 001 31.75 31.75 31.75 31,75-
TEAM CONFERENCE - 30 M99361
)2/22 1100051 001 31.75 31,75 31.75 31,75-
CASE MANAGER - PHONE C99371
12/22 1100054 001 127,25 127.25 127.25 127,25-
PHYSICAL PERMORMANCE T97750 .
)2/22 1100057 001 297.00 297.00 297.00 297.00-
PSYCHOLOGICAL EVALUATI90801
13/17 999999 001
ZERO CHARGE 00000
SUMMARY OF CURRENT CHARGES
60 PHYSICAL THRPY
965,00
965.00
965.001
965,00
965,00-
965,00
SUB-T TAL OF CURR, CHARGES
965.00
965.00-
B
SEX I M
TIME
I
I
NO I 1967464'68
PLACE i EMPL REL
TYPE
724,2
iGUAR
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ACC DATE
DIAGNOSIS
S
TOTALS
965.00' 965",00
965.00
965.00-
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PAY THIS AMOUNT
0,00
990229620
PINNACLE HLTH HOSP
HARR I SBURG, PA
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//
'.,.".: f'lyll\<:>111!1 fi(l.I1.I. ~;"Iln ~l\ll
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1(-1"1'1"-,,..) \.110 ;:(;()-lill)(l
i
April I, 1998
F:l'~'.IIT,'lI' olD ;!1)O..1.~h7
t-;111). .wwwprO'l'I";.,'\'I,,,,,'ll
Tristan Associates
4518 Union Deposit Road
Harrisburg, PAl 71 I I
Our Insured
Claim Number:
Date of Loss
Patient
Octavy Bounader
971062007
December 17,1997
Youssef Bounader
This letter is to infonn you the Progressive Companies has received your bills for services
rendered to the above named patient,
The necessary docwnentation has been submitted to a Peer Review Organization (PRO) for the
purpose of confirming that such treatment, products, services, or accommodations conform to the
professional standards of performance and are medically necessary,
Until the PRO decision is received by Progressive, we will not be in a position to consider any
future bills for the same treatment.
Upon receipt of the Peer Review Organization's findings, we will immediately inform you of our
position regarding payment.
PROGRESSIVE COMPANIES
ea.SSi 12 ,NeJ1Jla.nd
Cassi L. Newland
Medical Claim Representalive
cc: Handler & Wiener
'-
. , . , ,,\. . . . . . .' .' ..- .' . , .. . ,. .
'(~I .'
. ,h' PROGRESSIVE
April 1. 1998
:,;':':, i"'I,'n'l.'l,:'ll"),IlI, ';ull.J 310
1'lv"';1,,111 r.1c'\'IHlq. P^ 1n'll''''
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f' .I,.'.:"','," hm ~:'{]O..:.Il~T
'110 www plo'l: (";~~"~P l ',';n,
Rehabworks Inc, CMTN Harrisburg
1515 North Front Street
Harrisburg, PA 17102
Our Insured
Claim Number:
Date of Loss
Patient
Octavy Bounader
971062007
December 17, 1997
Youssef Bounader
This letter is to inform you the Progressive Companies has received your bills for services
rendered to the above named patient.
The necessary documentation has been submitted to a Peer Review Organization (PRO) for lhe
purpose of confirming that such treatment, producls, services, or accommodations conform to the
professional standards of performance and are medically necessary,
Until the PRO decision is received by Progressive, we will not be in a position to consider any
future bills for the same treatment.
Upon receipt of the Peer Review Organization's findings, we will immediately inform you of our
position regarding payment.
PROGRESSIVE COMPANIES
eaSSl ,e NeJ1Jland
Cassi L. Newland
Medical Claim Representative
cc: Handler & Wiener
'. .'. .' ',' ' . \ . ., . I . '" .," . ., ",' .
(' ',.
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./
PROGRE.f.fIVE
April I, 1998
.:;~ ;)',""'11111 p{'>,"j<J. Suolt.' ~,lt3
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11~11J "''lvW nt,','I'C'!;SIVI!.(:<311
Quantum Imaging and Therapeutic
52 Grumbacher Road #12
York, PA 17402
Our Insured
Claim Number:
Date of Loss
Patient
Octavy Bounader
971062007
December 17, ]997
Youssef Bounader
This letter is to inform you the Progressive Companies has received your bills for services
rendered to the above named patient.
The necessary documentation has been submitted to a Peer Review Organization (PRO) for the
purpose of confirming that such treatment, products, services, or accommodations conform to the
professional standards of performance and are medically necessary,
Until the PRO decision is received by Progressive, we will not be in a position to consider any
future bills for the same treatment.
Upon receipt of the Peer Review Organization's findings, we will immediately inform you of our
position regarding payment.
PROGRESSIVE COMPANIES
eassi ,e NeJ1Jland
Cassi L. Newland
Medical Claim Representative
cc: Handler & Wiener
"
. - . .
. . - ,. ' .' . . ... '.' , ..' " ", I' -' '. . . ~. ".. . .' _
April 1, 1998
South Central EMS, Inc.
8065 Allentown Blvd,
Harrisburg, PA 17112
Our Insured
Claim Number:
Date of Loss
Patient
Octavy Bounader
971062007
December 17,1997
Youssef Bounader
'-
l'i~>
.' r PROGRESSIVE
-'
/
'):-, ;,'I',m!'lllttllload. S\JII(~ :110
".1l101,\11 rv'cellnq, PA l\HG:?
TI;i"Jill()!l{' 010 2GO.fjlOO
r''''':'',L'll.!~1' (;10 ~GO..I,I(\i
1'1111 ".....ww pl(lq"'~,~;,...(, cOin
This letter is to inform you the Progressive Companies has received your bills for services
rendered to the above named patient.
The necessary docwnentation has been submitted to a Peer Review Organization (PRO) for the
purpose of confirming that such treatment, products, services, or accommodations conform to the
professional standards ofperfOlmance and are medically necessary,
Until the PRO decision is received by Progressive, we will not be in a position to consider any
future bills for the same treatment.
Upon receipt of the Peer Review Organization's findings, we will immediately infonn you of our
position regarding payment.
PROGRESSIVE COMPANIES
eassL f!, Nel1lland
Cassi L. Newland
Medical Claim Representative
cc: Handler & Wiener
"
\(~,
'.z. PROGRESSIVE
/'
/'
April 1, 1998
,~!, f'Jvl"nvll' ;~':';\rt ~:3lj'lo,l1li
Pr,.'l'LUHl >,'(:I.'\.nq, PA '~M(;2
",ol"lll':)"" ,,10 :?GO.(jl00
"If:':"""':' .,m ::00..1.107
"'1:; ..v..vw I.l'n(lr(";';,~'" corn
Pinnacle Health Hospital
Box 2353
Harrisburg, PA 17105
Our Insured
Claim NlUnber :
Date of Loss
Patient
Octavy Bounader
971062007
December 17, 1997
Youssef Bounader
This letter is to infonn you the Progressive Companies has received your bills for services
rendered to the 3 bove named patient.
The necessary documentation has been submitted to a Peer Review Organization (PRO) for the
purpose of confinning that such treatment, products, services, or accommodations confonn to the
professional standards ofperfonnance and arc medically necessary,
Until the PRO decision is received by Progressive, we will not be in a position to consider allY
future bills for the same treatment.
Upon receipt of the Peer Review Organization's findings, we will immediately infonn you of our
position regarding payment.
PROGRESSIVE COMPANIES
Ca,SSi J2 Nel11la,nd
Cassi L. Newland
Medical Claim Representative
cc: Handler & Wiener
.
,
,
i
i
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r
t
,
l .
, .. ~ " . , . . . '.' "., .' J- ." " . .... . "
,." '-
"..~.. PROGRESSIVE
/
April I, 1998
.~~)') ;"lyo,(",1I1 r'O;\rJ. ''';lj'l(o ~11(j
('>1-_,n'''llltl/.1''''IIIU1 Ph 10.:62
r.'!I 'PI",<}i"<I' hln ;>(0.r;100
1',1<.'.1<,,,101 .,If) ;:'(iO..I.ll;7
"ttp , -1'1'1'.'0'1 llrnq'f",'"v" ('(;111
Tristan Associates-Radiologist
4518 Union Deposit Road
Harrisburg, PA 17111-2996
Our Insured
Claim Nwnber :
Date of Loss
Patient
Octavy Bounader
971062007
December 17, 1997
Youssef Bounader
This Ictter is to infonn you the Progressive Companies has received your bills for scrviccs
rendered to the above named patient.
The necessary documentation has been submitted to a Pcer Review Organization (PRO) for the
purpose of confinning that such treatment, products, services, or accommodations confonn to the
professional standards ofperfonnance and are medically necessary,
Until the PRO decision is received by Progressive, we will not be in a position to consider any
future bills for the same treatment.
Upon reccipt of the Peer Review Organization's findings, we will immediately infonn you of our
position regarding payment.
PROGRESSIVE COMPANIES
eassl .e Newland
Cassi L. Ncwland
Mcdical Claim Rcprescntativc
.cc: Handlcr & Wicncr
, . . . .' - . , . ~ . ,.'~ <,' . t' , ; ',," ," . ., '" "' . .. ", .,' " . , . . . .'. \ . . " .
" ': \ , '~ ...'.' ~ . ~,> " . . '" ..' ):. . r : '," ,'~' .' ':."', '. L. ;"!... '_ " _,' _' _. . . >'
DANE K, WUK/ClI, M.D.
Board Cel1ilied Orthopaedic Surgeon
Practice Limited To Ol1hopaedie Surgery
June 19, 1998
Suzanne Sehl, R,N,
Company
Street
City
Attention:
RE: Youssef Bounader
iNSUliED:
CLAIM #:
OUR FILE #: 002213851-01
DATE OF BIRTH:
SOCIAL SECURITY:
Dear Ms, Sehl:
At your requesl, I reviewed the medical records that you forwarded to me regarding Youssef
Bounader. These records included the following:
I, Pinnacle Health, Polyclinic Hospital Emergency Room dat<:d December 17, 1997,
2, A bill for a chest x-ray datcd January 28, 1998,
3, The records of Bruce Goodman, M,D, from January 5, 1998 through April 14, 1998,
4, Physical therapy records from Health South dated January 5, 1998 through Fcbruary 5, 1998,
5, Records of Rehab, Works from January 23, 1998 through February 25, 1998,
6, Records of Harman Rehab, dated March 19, 1998,
7, A bill from Dr. Eugene York dated March 13, 1998,
SYNOPSIS OF RECOIWS REVIEWlill
~lUN 2 5 1S98
The rccords rencct that Mr, Bounader presented to the emergency room on December 17, 1997
after a motor vehicle accident. lie was the restrained driver of a sports utility vehicle which was
struck from behind at a licry lo\\' rate of speed, Th!.: emergency mum record rel1ects that
virtually no damage occurred to the rear end of the vehicle, The claimant tumed after the crash
.
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PAGE 2
10 view his wife and experienced the onset of low haek pain and neck pain, They reported that
the examinee initially felt very light headed, short of breath and had numbness in his hands
which had resolved, The examinee denied weakness, He complained of low baek pain and pain
in his neck, There was no direct trauma noted,
The assessment in Ihe emergency room indicated that the examinee had low back and cervical
strains, X-rays of the cervieal and lumbar spine did not reveal any acute changes, although there
were some degene~ative changes in his lumbar spine at L4.5, At that time, he was noted to be 32
years of age, He was discharged from the emergency room, The records reflect that after
discharge, the examinee camc undcr the care of Dr, Bruce Goodman, Dr, Goodman saw the
examinee on January 5, 1998, At that time, Dr, Goodman obtained a history. He indicated that
the examinee complained of neck and low back discomfort, He indicated that he was self
employed as a carpet and vinyl installer. He complained of neck and low back pain as well as
pain in his left rib at the site of the seatbelt. At that time, neurologically, his exam was normal.
Dr. Goodman did recommend an x-ray of the sternum and rib cage, He prescribed physical
therapy,
The records reflect that the examinee started physical therapy at Health South, He was seen
initially on January 5, 1998. At that time, he began a physical therapy program, His complaints
were neck and low back pain,
According to the records, he treated at Health South Rehab, through January 23, 1998 at which
time he was discharged at the request of Dr. Goodman, He had also had a functional capacity
test whieh indicated that he could not return to his work as a earpet installer.
On January 12, 1998, he continued to have back pain which was worse than neck pain, On
January 23, 1998, he was in a work conditioning program and was having discomfort in the right
leg down to his foot. He indicated that he "barely had any range of motion in his neek or low
back, They recommended discontinuing treatment and work hardening, Dr, Goodman
prescribed additional therapy which was begun at the Rehab, Works, The records reflect that
Rehab, Works treated the examinee beginning on January 23, 1998 which is the day the
examinee was discharged from Health South, According to the Rehab, Works initial encounter,
the examinee had a comprehensive initial assessment and had tenderness in the entire cervical
region as well as the lumbosacral regions, The records relJect that he treated at Rehab, Works
through February 25, 1998, Pelvic traction was initially added to his treatment regimen,
~On January 28, 199R, the claimant noted chest pain .uld Dr. Goodman referred the examinee to
the emergency room for evaluation, I Ie had a chest x-ray and an EKG which were negative.
Therapy was resumed, On January 30, 199R. Dr. Goodman noted that he was improved with
therapy, At that time, he recommended wntinuing physicallherapy and beginning aqua therapy,
On February 6, 1998, he was noted to have improvement with therapy, Once again, therapy was
recommended to continue,
cJUH 2 5 1$98
.
RE: 1l0UNADER, YOUSSEF
l'AGE3
Rc-cvaluation on Fcbruary 13, 1998 indicatcd tbat tiT<: claimant bad not rcccivcd thcrapy the day
bcfore or that day becausc of allegcd low back discomfort. At Ihal limc, positivc Waddell
findings werc noted, Dr, Goodman recomllTendcd an MRI sludy of the lumbar spine as well as
Norllex and Valium, The cxaminec had an MRl study donc according 10 Dr, Goodman's notes,
Dr, Goodman discussed the results of the MRI with the examinee on Fcbmarv 20, 1998, He
then recommended continuing wilh aqua thcrapy and then on March 29, 1998, Dr, Goodman
indicated the examinee should continuc with active and passive rangc of motion while
perfornTing aqua therapy,
On March 19, /998, the claimant was seen by Dr, Hartman, Dr. Harlman indicated that the
examinee complained oflow back and pain in the neck radiating down his right upper extremity,
Dr. 'Hartman indicated that he had an MRI of the lumbar spine indicating mild degenerative
changes with slight disc herniation, central and right lateral. It was indicated that this was
sub ligamentous, Apparently, thc examinee had also been treated with a Medrol dose pack, Dr.
Goodman's office notes indicated that the examinee's MRI study did not indicate any evidence
of spinal stenosis or disc herniation althougl.there was bulging at the L4-5 level, There appeared
to be some discrepancy between Dr, Hartman's impression and Dr. Goodman's impression, In
any event, Dr. Hartman felt that he had a post traumatic cervical, thoracic and lumbosacral strain
with a possible right cervical radiculopathylbrachial plexopathy, He indicated he also had
sacroiliac syndrome, He recommended a,prescription for Lodine and Skelaxin and an MRI of the
cervical spine, The records rel1ect that the claimant came back to see Dr, Goodman on April
14,1998, He continued to have complaints of pain in his neck, mid back and low back with no
relief from aqua thcrapy, At that time, Dr, Goodman indicated that he was unable to explain his
continued symptomatology and the examinee was going to go for a second opinion, Dr.
Goodman did type up a report dated April 24, 1998 indicating that the claimant was unable to do
his job as a carpet installer and was scheduled to see Dr. Cho on April 25, 1998,
CONCLUSIONS
Aftcr rcvicwing the mcdical rccords, it is my opinion that thc treatmelll rcndered to this examinee
was appropriate and mcdically necessary, I havc revicwcd trcatment up to and including Dr.
Goodman's note of April 24, 1998, The refermls for Physical Therapy at Health South and
Rehab Works wcre appropriate, The diagnostic testing which included an MRI of the lumbar
spine would be appropriatc for the continued complaints of low back pain with complaints of
~jght lower extremity pain, I did not have a copy of the MRI report, however, to review. In
addition, the rccommendation by Dr. Hartman to proceed with a cervical spine MRI would be
appropriate for neck pain and pain radiating inlo the righlupper extremity, Thc recommendation
for physkal thcrapy was appropriate in my opinion, This examinee initially had a hrief period of
therapy with Health South frollT January 5. 1998 through January 2,'\, 199X which seems to b,:
mme of a work hardening program, SlIbS(:qllelllly, thc therapy was discontinued and the
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v,
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LA W
NO, 99-02555
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,
YOUSSEF BOUNADER,
Plaintiff
PROGRESSIVE INSURANCE
COMPANY,
JURY TRIAL DEMANDED
Defendant
DEFENDANT'S PRELIMINARY OB.IRC-TIONS TO PLAINTIFF'S COMPLAINT
I, Plaintiffs Complaint was filed on or about April 28, 1999,
2, In that Complaint the Plaintiff alleges he was in an automobile accident on December 17,
1997, in which a vehicle collided with the rear of Plaintiffs automobilc,
3, Plaintiff alleges as a rcsult of the collision he sustained serious bodily injuries and was
compelled to undcrgo mcdical attention and care,
4, Plaintiff alleges Defcndant failed to pay mcdical bills rclatcd to thc trcatment ofPlaintitrs
injuries from said accidcnt.
5, Plaintiffallegcs Dcfcndant acted in bad faith whcn submitting Plaintiffs mcdical bills to
a Peer Rcvicw Organization (PRO) to conduct a review of Plaintiffs mcdical bills,
6. Count III ofPlaintifrs Complaint alleges bad faith usc of a PRO by Defendant that rises
to thc Icvel of wanton conduct. Plaintiffs Complaint rcqucsts treblc damages for said wanton
conduct undcr 75 Pa, C,S.A. S 1797(b)(4),
7. 75 Pa,C,S,A, S I 797(b)(4) awards trcblc danlagcs for wanton conduct by an insurer who.
f.1ils tn suhmit medic~l hills In a PRO for review, Trcblc damages arc not awarded undcr this section
for bad faith submission to a PRO,
8, Dcfcndant submittcd thc mcdical bills in question to a PRO, so docs not fall under the
reach of75 Pa,C,S,A, S l797(b)(4), Thc case of Mclnlyrc v Slate Fann Allin Ins Co" 47 Cumb,
206 (1998), addressed S I 797(b)(4) and stated that this statutc is to be uscd to deal with thc situation
where an insurer rcfuscs to pay medical bills without challenging thc treatment before a PRO,
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4. On or about Deccmbcr 17, 1997, Plaintin: Yousscf Bounadcr, was stoppcd at a rcd
light on Routc 22, Harrisburg, Dauphin County, Pennsylvania, whcn a vchicle owned and opcratcd
by Mildrcd Yezdimir struck thc rcar of Plainlitrs vchiclc. As a rcsult of this collision, Plaintiff
sustaincd cxtensivc and scvcrc pcrsonal injuries.
5. On or about February 10, 1997, Plaintitrs wife, Octavy Bounadcr, had purchascd a
policy of motor vchiclc insurancc with thc Dcfcndant insurancc company through its authorized
agent, Shiner Insurance Agency, at 1001 S. Market St., Mechanicsburg, Cumberland County, PA
17055. Said policy was in full force and effect on December 17, 1997, the date of the collision.
6. Pursuant to the terms and conditions of said policy with Defendant, Progressive
Insurance Co., Plaintiff, Youssef Bounader, was an insured. In addition, Plaintiff and his wife had
paid an additional policy premium to obtain $100,000 in first party medical loss benefits in accordance
with the Pennsylvania Motor Vehicle Financial Responsibility Law, P.S. ~ 1701, et seq, as amended.
7. As a result of the collision, Plaintin: Youssef Bounader, sustained serious bodily
injuries, including, but notlimitcd to, cervical, thoracic and lumbosacral strains; sacroiliac syndrome;
myofascial pain; and persistcnt lower extremity radicular symptoms, compatible with a right L5-S I
herniated disk
8. As a further result oflhe aforementioned collision, PlaiI1lilrhas been compellcd 10
receive and undergo cxlensi\'e medical attention and care and to expcnd large sums of money and/or
,
,
-.
10. II is averred that all medical bills havc becn, and continuc to bc, filiI', rcasonable, and
mcdically ncccssary, and that all trcatmenl has becn, and continues to be, rclatcd to Ihc
aforcmentioncd incident.
11. From the commcnccmcnt of treatment, and al various times thcreaftcr, Plaintiff,
Youssef Bounadcr, and his medical care providcrs havc rcquestcd thaI Dcfendant pay thc
aforcmentioned medical bills as they have been accumulating.
12. Plaintiff's credit histol)' will bc adversely affecled as long as Defendant continues to
deny responsibility for paymcnt of reasonable, nece"ary, and related medical trcalmcnt.
13. Plaintiff's third-party pcrsonal injury claim will bc advcrsely affcctcd as long as
Defendant continues to deny responsibilily for payment of reasonable, necessary, and related medical
treatment.
14. Dcfendanl, Progressive Insurancc Company, pursuant to ~ 1 797(b)( I) of the
Pennsylvania Motor Vehiclc Financial Responsibility Law, as amended, has comracted wilh a peer
rcview organizalion (PRO) for Ihe allegcd purposc of confirming Ihat said trealment conllJl'lned to
profcssional standards ofperlonnancc and medical necessily. Thc name and address of said PRO is:
Claims Review Associales, 660 American A vcnue, Suile 103, King of Prussia. Pcnnsylvania
(hereinalier "CRA").
4
. ' .' - , " .. - . ~ .'. " ..... .
-
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15. On April I, 1998, Dcfendant, Progressive Insurancc Company, referred Plaintill's medical
bills from the following providers to said PRO:
(I) Uptown Cardiology Associates:
(2) Tristan Associates;
(3) Pinnacle Health Hospital;
(4) Rehab Works, Inc.;
(5) Quantum Imaging;
(6) South Central EMS, Inc.;
(7) Bruce Goodman, M.D.;
(8) Health Soulh Rehab of Mechanicsburg; and
(9) Community General Osteopathic Hospital.
Copies of all refcrralletlers are attached hcreto, made a part hcreof, and marked, "Exhibit B."
16. Referral of the providers' bills in this case is in violation 01'31 Pa.Code ~69.52(a),
under which a provider's bill shall bc refcrrcd to a PRO only whcn circumstances or conditions
relaling to mcdical and rehabilitative services provided causc a prudent person, familiar with PRO
proccdures, standards and practices, to believc il neccssary Ihat a PRO detcrmine Ihe reasonableness
and necessity of carc.
17. Pursuant to 31 Pa.Codc ~ 69.52(a), Ihe insurer shall notify all providers. in writing and
allhe lime of the refcrral, when referring bills to a PRO review.
18. A number of mcdical pl'Ovidcrs. including Dr. Sluart Hartman and Kalhy Stcwart,
L P. T., thc physicallherapist. were nol nOlified in writing of Defendanl 's intenlionlO refer Iheir bills
10 a PRO revicw, despitc Ihe factlhallheir bills were subsequenlly dcnicd onlhe basis of the PRO
rc"ic\\?
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19. Pursuant to 31 Pa.Code ~69.52(c) the PRO shall requcst in writing, from the providers
under revicw, all records and documcnts ncccssalY to undcrtake its rcvicw.
20. Claims Review Associatcs failcd to forward a writtcn rcquest for all relcvant rccords
and documcnls to any of the providers being revicwcd.
21. Pursuantlo 31 Pa.Code ~ 69.52(c), the PRO shall afford the providcrs an opportunity
to discuss the case with Ihc reviewer and to submit any information to the rcviewcr.
22. Claims Revicw Associates did not afford the providcrs, and particularly Dr. Sluarl
Hartman and Kathy Stewart, L.P.T., thc opportunity 10 discuss the case with thc rcvicwcr or to
submit information to the reviewer.
23. On June 19,1998, Dr. Dane K. Wukich, an orthopedic surgeon whose praclice is
"limited to orthopedic surgcry," completed his peer revicw of the treatment providcd to Plainliff,
Youssef Bounader. A copy of Ihe peer review rcport is attached hereto, made a part hcrcof and
marked, "Exhibit c."
24. Al the time of his revicw, Ihc rccords Dr. Wukich rclied on werc limilcd 10 Ihe
following:
(I) Pinnaclc Hcalth, Polyclinic Hospital Emcrgency Room, daled Dcccmbcr 17, 1997;
(2) A bill for a chest X-ray, dated January 28, I'J,)S:
(3) Thc rccords ofBrucc Goodman. 1\1 D. from Janual)' 5, 19981hrough April 14. 1998;
II
" ., ' ,,' " ~ .: " --- . . , '. " .~. . . .
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35. Plaintiff belicves, and thereforc avcrs, that thcre was no rcasonablc basis to deny
paymcnts bascd on the June 19, 1998, pIleI' revicw report, because Dr. Wukich makcs no conclusions
regarding thc medical ncccssity oflreatment allcr May J 7, 1998.
36. Pursuant to 31 Pa.Codc * 69.S2(c), a PRO's writtcn analysis shall includc spccific
reasons for its decision.
37. Plaintiff believes, and therefore avers, that Dr. Wukich did not includc spccific rcasons
for his opinion in the Junc 19, 1998, report.
38. Plaintiff belicvcs, and therefore avers, that there was no reasonablc basis to dcny
payments because Dr. Wukich's reports relied upon blankct charactcrizations of accepted procedure
without any physical examinalion ofYoussefBounadcr. The peer revicw did not consider Plaintiff's
prior health, specific injury, mechanism of in jUlY, or his currcntmedical condition bctore reaching its
. conclusion.
39. Plaintifffunhcr avers that there was no reasonable basis to dcny paymcnls based on
the June 19, 1998, peer rcview report becausc Dr. Wukich did not pcrtonn a dctailcd analysis of the
case and ovcrlooked spccific tilidings.
')
. .
.. '.
. .
(a) Represenling that the PlainlitT, Youssef Bounader, would be covcred by the lull
amount oflhe medical benefits purchased undcr the abovc-referenccd policy,
when, in fact, said promise was wholly illusory;
(b) Purporting to offer a specified amount of mcdical coverage, when, in 1:1Ct,
Dcfendant had no intention of providing coverage to said cxlcnt;
(c) Charging a prcmium, based on a specificd amount of medical benctils, whcn
in fact, Dcfendant purposely avoided fulfilling its contract 10 provide said amount
of bencfits;
(d) Denying Plainliff, YoussefBounader, mcdical benefils and/or payment of medical
benefits withoul a rcasonable basis;
(e) Refusing 10 pay Ihe Plaintiff's claim wilhoul conducting a reasonable invcsligalion
based upon all availablc information;
(f) In failing 10 use Claims Review Associatcs to cva!uale the reasonablcness and
neccssity of mcdical trcalment, bUI, rather, in using said PRO in lorm only as a
pretcxt for denying Plainlifl's first-party claim;
(g) in cmploying Claims Review Associales, due to said PRO's financial interesl in
providing Defcndants wilh a biascd report;
(h) Nol allcmpling, in good faith, to etfeclualc prompl, fair, and equilablc
covcrage of claims, oncc Ihe Dcfendant's rcsponsibility undcr ils policy of
insurancc had becomc rcasonably clear;
(i) Failing 10 c\'aluatc and dcterminc Plaintilrs entitlcmcJ1l for trcatmcnt rcndcrcd,
based uponlhc tcrms of the policy prm'iding co\'cragc 10 Plaint in: Yousscf
I~
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VERIFICATION.
THE UNDERSIGNED hereby verifies that the statements in the foregoing
document are based on infonnation that was gathered by counsel in preparatiun of this
lawsuit. The language of the above-named documcnt is of counscl and not my own. I
have read the said document and, to the extent that it is based on infonnation that I gave
to counsel, it is true and correct to the best of my knowledge, infonnation and belief. To
the extent that the contents of the said document is that of counsel, I have relied upon
my counsel in preparing this Verification.
THE UNDERSIGNED also understands that the statements therein are made
subject to the pcnalties of 18 Pa.R.C.P. 2252(d) C.S. Section 4904, relating to unswom
falsification to authorities.
DATE: C Il'2J q "'1
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l10U6468-00 ( YOUSSH OOUNf\IJF.R, Home ( 717 )651-0905)
(Insurance 10; 971062007 CLN)
03/19/98 SAH 3 76 723.4 99245 1 QO .00 '.
00/04/98 StlH 76 PMV,," -143.64
013/04/98 SAH 76 AIWA -1'\6.]()
( I nsu ,. a nC,(t I bi lIed 03/2~>/90 ) I
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04/23/98 SAH 3 600 847.0 99214 8~, .00 ,.
08/04/98 SAH 608 PIWA -41 .48
OF.l/04I'Jn SAH 60'3 AMVA -4l S)
( I nsur ,) nee 1 b i.ll cd 04/27/98 )
OS/21/98 SAH 3 1111 847.0 99214 8S .DO
( Insurance I billed OS/28/98 )
07/30/98 SAH 3 2186 847.0 20550 1:;10.0C'
0'1/30/98 Sf\H 3 2106 847.0 99214 85.00
11/11/98 SAH 2186 CMDN 0.00
11/11190 S/'>H 2186 CALL 0.00
( pat.ient billed 11/12/98 )
( rnsu~ance 1 billed 08/05/98 )
09/00/98 SAH 3 2761 847.0 99214 85.'Jr)
( Insll~ance 1 bill ed 09/15/98 )
10/15/913 SAH 3 3312 729.1 64450 120,00
( Insul'ance 1 billed 10/20/98 )
11/24/,913 SAH 3 3910 724.2 99214 85.00
01/25/99 SAH 3910 INSRJ 0.00
( Pat~ient bill ad 01/25/99 )
( Insurance 1 bill ed 12101/913 )
01126/99 SAH 3 4746 724.2 99213 60.00
03/09/99 SAH 4746 . PEER 0,00
( Insurance 1 billed 01/27/99)
02/12/99 5Mt 3 .. 5033 NDRPT 125.00
02/25/99 5AH 5033 PMEO -12.5.00
( Insurance 1 bi iled 02/16/99)
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DISCOVER & AMER.EXP
ACCOUNT NUMElEA AND NAME
98034B438
BQUNADER ,YOUSSEF
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(717)657-7443
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PINNACLE HeALTH HOSPITALS
BOX 2353
HARRISBURG. PA 17105
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4308 KOTA AVE
H^RRI~BURG PA 17110-9595
724.2
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QUESTlONS? Ph...C.U: (717)657-7443
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1 MOBILIZATION
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1 EXERCISE
4 OP SUPV PT 1S
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1 ELEC STIMULATION
3 OP SUPV PT 15
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1 MOBILIZATION
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05/15/9B
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DATE or
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HArmISBURG, PA "
717 230-3717 DSS
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03/25/99
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02/15/99
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ADDRESS
YOUSSEF BOUNADER
1.308 KOTA AVE
HARRISBURG PA.17110
(,O.D. INSlJllANC[ COMI'MH 'IAM( jGIWUI' toUMUUl POliCY HUMBER
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1 HEALTH ASSURANCE 21058121800
1 AUTO A-Z I .~
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HARTMAN STUART A
CUAAANTOA
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PLEASE RETURN THIS PORTION WITH YOUR PAYMENT,
DESCRIPTION Of
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CODE
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PATIENT
M,lQUNT
OF CURRENT CHARGES, PAyrENTS AND ADJUSTMENTS
2/22 1100045 001 127.25 127.25 127.25
THER PEUTIC ACT 60 MINOOOOO ...
2/22 1100047 001 31.75 31.75 31.75
WORK RELATED MEDICAL 099456
2/22 1100048 001 191.00 191.00 191.00
MUSCLE TEST RANGE OF M95831
2/22 1100049 001 127.25 127.25 127.25
BIOFEEDBACK TRAINING 690900
2/22 1.100050 001 31.75 31.75 31.75
TEAM CONFERENCE - 30. M99361
2/22 1100051 001 31.75 31.75 31.75
CASE MANAGER - PHONE C99371
2/22 1100054 001 127,25 127.25 127.25
PHYSICAL PERMORMANCE T97750 .
2/22 1100057 001 297.00 297.00 297.00
PSYCHOLOGICAL EVALUATI90801
3/17 999999 001
ZERO CHARGE 00000
127.25-
31.75-
191.00-
127.25-
31.75-
31.75-
127.25-
297,00-
SUMMARY OF CURRENT CHARGES
60 PHYSICAL THRPY
965.00
965.00
965.00
965.00-
SUB-T TAL OF CURRo CHARGES
965.00
965.00
965.00
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GUAR RELATIONSIIIP
ACC DATE
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5
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;. Ill"." lilll,,).j, 1 ~:,.'Il' :lll~
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April I, 1998
:'::''':JI~C'',! ,;10 !,.jtl.;Jl(,O
rllC:'Il1IU ,,10 ::0(....:.1\17
!,lln '.W".W 1;I(Jq")~',~;,,,,P com
Uptown Cardiology Associates
5499 William Flynn Hwy_ 11200
Gibsonia, P A 15044
Our Insured
Claim Number:
Date of Loss
Patient
Octavy Bounadcr
971062007
Deccmber 17, 1997
Youssef Bounadcr
This letter is to infonn you Ihe Progressive Companies ha1reccived your bills for services
rendered to the above named patient
The necessary docllll1entalion has been submitted to a Peer Review Organization (PRO) for the
purpose of confinning that such treatment, products, services, or accommodations confonn to the
professional standards of perfonnance and are medically necessary_
Until the PRO decision is reccived by Progressive, we will not be in a posilion 10 consider any
future bills for the same trcaUl1ent
Upon reccipt of the Peer Review Organization's findings, we will immedialely infonn you of our
position regarding payment
PROGRESSIVE COMPANIES
CaSSi J!, f\Jel1J[al1d
Cassi L Ncwland
Mcdical Claim Reprcsentalive
cc: Handlcr & Wiener
EXHIBIT B
";
l()>-):'
.- .LV PflOIJRESJ/IIE
/"
.;~~ Ply"">'_':" nO,-1l1 ~~\J<\(: J":
["'1"/1,,(:,,'1" :,'ll';.hl'(I. P^ \'),:-:,::
'1"eC'"':"('. til0 :>flO-Ul,:~
April!,1998
':;,C!;,'l"'4J ,,10 ::'::IIJ.';~':J'
.':'p ., W.NW r,'C.'C:';;~~"..f! '~cn\
Pinnaclc Hcalth Hospital
Box 2353
Harrisburg, l' A 17105
Our Insurcd
Claim Number:
Date of Loss
Paticnt
Octavy Bounader
971062007
Dccembcr 17, 1997
Youssef Bounader
This letter is to infoml you the Progressive Companies ha! received your bills for serviccs
rendered to Ihe above named patient.
The necessary docllll1entation has becn submitted 10 a Peer Review Organization (PRO) for the
purpose of confinning that such lrealmenl, products, services, or accommodations conform to the
professional standards ofperfonnance and are medically necessary.
Until the PRO decision is received by Progressive, we will not be in a position to consider any
future bills for thc same treatment.
Upon rcceipt of Ihe Peer Review Organization's findings, we will immedialely infonn you of our
position regarding payment.
PROGRESSIVE COMPANIES
Cassi ,C f\Jehltal1d
Cassi L. Newland
Medical Claim Rcpresenlalivc
cc: Handler & Wiencr
~ . . . ",." ,I " . I ~ . " " ," , .' ] "." " . I ", , , . - '
. .
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//
April 1, 1998
~ ~:. Pt.,.'"()U\t' ;:<'x.!u. SUite 316
c"~.(l,.",:t\ 'l('e!,,")' "" 1~Mll2
If_,t'~f:tlOI\,, (,10 ~GO.6\OD
~;lcs,m.t(' t'>10 .2CO..L167
11~!p www nr,"Jqrc!:;~.'ya con,
Quanlum Imaging and Thcrapcutic
52 Grumbacher Road II 12
York, PA 17402
Our Insured
Claim NUIl1ber :
Date of Loss
Patient
Octavy Bounader
971062007
December 17, 1997
Youssef BOlll1ader
This letter is to inform you the Progressivc Companies hJ received your bills for services
rendered to the above named patient
The necessary documentation has been submitted to a Pcer Review Organization (PRO) for the
purpose of confirming Ihat such treatmcnt, products, services, or accommodations conform to the
professional standards ofperfonnance and are medically neccssary,
Until thc PRO decision is received by Progressive, we will not be in a position to considcr any
future bills for thc same treatment
Upon rcceipt of the Peer Review Organization's findings, wc will immediately inform you of our
position rcgarding paymcnt.
PROGRESSIVE COMPANIES
Ca.SSl J!, /'JO\lltl.1td
Cassi L Ncwland
Mcdical Claim Rcpresentativc
ec: Ilandlcr & Wicncr
'.
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/'
April I, 1998
.:':', Ptv"'nllll)II(};}ll.~1JI111 :111)
;l'Vm(~"trl t.l')f'I~".J. P^ 1!:l4(i2
ICI'lOI10"'! 1)10 :?GO.{jl{)O
",1(';';"1111'1 (110 ~lljf)"l.IG;
l'llp' "WW\N IJr0q'e!~~.,,,,, Cl),n
South Ccnlral EMS, Inc.
8065 Allcntown I31vd.
Harrisburg, PA 17112
Our Insurcd
Claim Numbcr :
Date of Loss
Patient
Octavy Bounadcr
971062007
Dcccmbcr 17, 1997
Youssef Bounader
This leiteI' is to inform you the Progressive Companics ha;-rcceived your bills for services
rendered to the above named patient.
The neccssary documentation has been submittcd to a Peer Review Organization (PRO) for the
purpose of confirming that such treatment, products, services, or accommodations conform to rhe
professional standards of performance and are medically necessary.
Until the PRO decision is received by Progressivc, we will not be in a posilion to consider any
future bills for the same Ireatment.
Upon receipt of Ihe Peer Review Organization's findings, wc will immediatcly inform you of our
position regarding payment.
PROGRESSIVE COMPANIES
e assi J2 .NeJtJlal1d
Cassi L. Newland
Medical Claim Represcntativc
cc: Handlcr & Wicncr
'..
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I
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I
I
I
I
I
)~} PROCRESSIVE
/"
April I, 1998
;'!, Ply" ")u1l11 ~L'.ld ::.''It! :JIG
I '1,..,110.,111 t'~"'.'l""l P^ '~hlG2
T,!""lJ!\lln" l;1O :'GO.fllOO
i';.lC:;'I1lII11 ';10 ~60..14li7
"1111 'hWW f)rO("J'e~;':i,vo.curn
Brucc Goodman, M.D.
1515 North Fronl Strcet
Harrisburg, P A 17 I 02
Our Insurcd
Claim Number:
Date of Loss
Palient
Octavy Bounader
971062007
December 17, 1997
Youssef Bounadcr
This letter is to inform you the Progrcssive Companics has1receivcd your bills for services
rendered to the above named patient.
The necessary doc\lll1entation has becn submitted to a Pcer Review Organizalion (PRO) for the
purpose of confirming that such treatment, products, services, or accommodations conform to thc
professional standards of performance and are medically nccessary.
Until thc PRO decision is reccivcd by Progressivc, we will nol bc in a position 10 consider any
fUlure bills for the same Ireatment.
Upon receipl oflhe Peer Review Organizalion's findings, we will immedialcly infonn you of our
posilion rcgarding payment.
PROGRESSIVE COMPANIES
CassL f!, NeiV{a,1td.
Cassi L. Newland
Medical Claim Rcprescntative
. cc: Handlcr & Wicncr
)
./j;~ PRtJBRESSIVE
../..
April I, 1998
:';".1 i>lvJ!1o\Jlll n..laG. GwlO ;116
;'1'/11101 ,It I MI~\!l1f1'J, f~A Hl4G2
r.:.jf.'pt';onl~ Ij\O :tGO.GlOO
rnc~1l1,1~ 3102GO..1dfj,
"llp. 'www pIOlJrl.r,5'Y(~ cQln
Trislan Associatcs-Radiologist
4518 Union Deposit Road
Harrisburg, PA 17111-2996
Our Insured
Claim Number:
Dale of Loss
Patient
Oclavy Bounadcr
971062007
Deccmber 17, 1997
Youssef Bounader
1
This letter is to infornl you the Progressive Companies has received your bills for services
rendered to the abovc named patient.
The necessary docwnentation has becn submittcd to a Peer Review Organization (PRO) for the
purpose of confirming that such treatmenl, products, services, or accommodations conform to the
professional standards ofperformancc and are medically necessary. '
Untillhe PRO decision is reccived by Progressive, we will not be in a position to consider any
future bills for the same treatment.
Upon receipt oflhc Pcer Review Organization's findings, we will immcdiately infoml you of our
position regarding payment.
PROGRESSIVE COMPANIES
e assL 12 Ne/1Jland.
Cassi L. N cwland
Medical Claim Rcprescntativc
cc: lJandler & Wicner
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to vicw his wife and experienced the onscl of low hack pain and neck pain. Thcy rcportcd that
thc examinec initially felt \'Cry light healkd. shnrt of breath and had numhncss in his hand,
which had rcsolved. The cxamince dcnied weakncss. IIc complained of low back pain and pain
in his ncck. Thcrc was no dircct trauma notcd.
Thc asscssmcnt in thc emergcncy room indicatcd that the examinee had low back and ccrvical
strains. X-rays of thc cervical and lumbar spinc did not rcveal any acutc changcs, although there
wcre some degenerativc changes in his lumbar spinc at L4-5. At that time, hc was noted 10 be 32
years of agc. Hc was discharged from Ihc emcrgcncy room. The rccords rcl1ecI that after
dischargc, the cxamince came under thc carc of Dr. Bruce Goodman. Dr. Goodman saw the
examinee on January 5, 1998. At that time, Dr. Goodman obtained a history. He indicated that
thc cxaminee complained of ncck and low back discomfort. He indicatcd Ihat hc' was self
employed as a carpet and vinyl installer. He complaincd of ncck and low back pain as wcll as
pain in his left rib allhe sitc of Ihc sealbelt. At that time, neurologically, his exam was normal.
Dr. Goodman did rccommend an x-ray of the slemum and rib cage. He prescribed physical
Iherapy.
The records rcl1ccI thaI the examinee slaTted physical therapy at Health South. Hc was seen
initially on January 5, 1998. Al'lhattimc, he bcgan a physicallherapy program. His complainls
were neck and low back pain.
,
According to the rccords, he trealed at Heallh South Rehab. through January 23, 1998 al which
time he was discharged at thc rcquest of Dr. Goodman. He had also had a functional capacity
Icsl which indicated Ihat he could nol relurn to his work as a carpet installer.
On January 12, 1998, he continued- to havc back pain which was worse than ncck pain. On
January 23, 1998, he was in a work conditioning program and was having discomfort in .ihc righl
lcg down 10 his foot. He indicated Ihat hc "barely had any rangc of motion in his ncck or low
back. Thcy rccommended discontinuing Ircalmenl and work hardcning. Dr. Goodman
prcscribed addilional Iherapy which was begun at Ihe Rehab. Works. Thc rccords rctlecI Ihat
Rchab. Works Irealcd the examinee bcginning on January 23, J 998 which is Ihc day thc
cxaminec was dischargcd from Ilcalth South. According to the Rehab. Works inilial cncounler,
thc cxaminec had a comprchensivc initial assessmcnl and had tcndcmess in thc cntire ccrvical
region as well as the lumbo:;acral rcginns. Thc records reflcct Ihat hc Ircalcd at Rehab. Works
Ihrough Fcbruary 25,1998. 1'<:lvic lraclion was initially added to his Ircatmcnl regimcn.
~On Janu:U)' 28, 1998, thc elaimant nolcd chcst pain :Uld Dr. Goodman rcfcrrcd Ihc cxamince to
thc cmcrgcncy room !(ll evaluation. lie had a chest x-ray and an EKG which wcre negative.
Therapy W:lS resumed. Oil J:lIlu:Uy' 30. 1995, Dr. (Joodman noted thaI he was improvcd with
therapy. At that time, he ICC<\l11mendcll continuing phy::icaltherapy and bcginning aqua thcrapy.
On Febru:ll)' 6,1')98, hc was 110ld 10 h:1VC impro\'cmenl wilh thcrapy. Once again, thcrapy was
lecommendc,!to conlinue'.
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RE: nOUNAllEn, YOUSSE'I'
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Rc-cvaluation on February I J, I <)l)S indicated Ihal 111l' c1aimalll had notlcceiveu therapy the clav
bcfore or that day becausc of allcged low back discomfort. At that timc, positivc Waddeil
findings wcre noted. Dr. Goodman rccommcnded an MRI study of thc lumbar spine as wcll as
NorOex and Valium. The examinec had an MRI study donc according to Dr. Goodman's notes.
Dr. Goodman discusscd the rcsults of thc MRI with thc examincc on Fcbruary 20, 199H. He
thcn recommcndcd continuing with aqua therapy and then on March 29, 1998, Dr. Goodman
indicated the examinee should continue with active and passive rangc of motion while
perfornling aqua thcrapy.
On March 19, 1998, the claimant was sccn by Dr. Hanman. Or. Hartman indicalcd thaI the
examinee complained of low back and pain in thc ncck radialing down his right uppcr extremity.
Dr. 'Hartman indicated that he had an MRI of the lumbar spine indicating mild dcgcncrativc
changes with slight disc herniation, ccntral and righl latcral. lt was indicaled that this was
subligamentous. Apparently, thc examinee had also been trcalcd with a Medrol dosc pack. Dr.
Goodman's office notes indicaled thaI the cxaminee's MRI study did not indicate any cvidcnce
of spinal stenosis or disc hcrniation although. thcrc was bulging at thc L4-5 level. Therc appeared
to be some discrepancy between Dr. Hartman's impression and Dr. Goodman's impression. In
any evenl, Dr, Hartman felt that he had a post traumatic cervical, thoracic and lumbosacral strain
with a possible right cervical radiculopathy/brachial plexopalhy. He indicated he also had
sacroiliac syndrOr1le. He recommended a.prescription for Lodine and Skelaxin and an MRI of the
cervical spirie. TIle records reflect that the claimant camc back to see Dr. Goodman on April
14, 1998. He continued to have complaints of pain in his neck, mid back and low back with no
relief from aqua thcrapy. At that lime, Dr. Goodman indicatcd that he was unable to explain his
continued symptomalology and the exanlinec was going to go for a sccond opinion. Dr.
Goodman did typc up a rcport datedlApril 24, 1998 indicating Ihat the claimant was unable to do
his job as a carpet installer and was schcdulcd to sce Dr. Cho on April 25, 1998. .
CONCLUSIONS
After rcvicwing thc mcdical rceords, it is my opinion that thc Ircatmcnt rcndercd to this cxaminec
was appropriatc and medically nccessary. I havc revicwed treatmcnt up to and including Dr.
Goodman's notc of April 24, 1998. The rcferrals for Physical Therapy at Health South and
Rchab Works wcrc appropriale. Thc diagnoslic tcsting which included an MRI of thc lumbar
spinc would be appropriate for the continued compbints of low back pain with complaints of
:righl lower cxtrcmity pain. I did not havc a copy of the MRI report, howcvcr, to review. In
addition, thc recommcndation by Dr. Hanman to proceed wilh a cervical spine MRl would bl'
approIll'iatc for neck pain and pain radiating intn the right upper extremity. Thc recommendation
for physicallherapy was appropriate in my opinion. This examinee initially had a hricf period of
thcrapy wilh Health South from January 5, I 'J'J8 througb January 23, I <)98 which seems to be
morc of a work hardenin!~ plOgr;lm. Subsequently, the ther:lpy was discontinued ;!Ild the
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RE: 1l0UNAIlEll, YOUSSEF
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examince transfclTed 10 Ihcrapy 10 Rchah. Works bcginning on January 23, 1 <J<JH and continuing
unlillhc cnd of Fcbruary of 19<JH.
Thc Icngth of Ireatmcnt in this particular casc docs appear 10 bc appropriatc for the diagnosis of
soft tissuc slrains involving thc ccrvical and lumbar spincs complicatcd by complaints of pain in
thc cxtrcmity as wcll. The timc interval bctwccn injury ancltrcalmcnt is usual and customary.
Maximum mcdical improvcmcnt would bc cxpcctcd in thc vcry ncar futurc. Typically, palients
rcach MMI within six months aftcr a soft tissuc injury. If the MRI of the ccrvical spinc does not
show any significant slruclurallindings, Ihcn I would cxpect MMI would bc rcachcd on or about
May 17, 1998 which would bc about six months from thc lime of injury.
Should you havc any furthcr questions, plcase do not hesitate to COIJIact mc.
Sinccrely yours,
Dane Wukich, M.D.
Orthopaedic Surgeoll
OWl" 119422.I)OC
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)7 P/lUOREJJIVE
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Junc 29, 1998
525 PtylflOUUl nO:lrJ, Suito 310
Plymouth Mooling, PA 1~J462
Tolephono; 610260.6100
Fncsln"lo: 6102130-4407
j,tlp.ffwww pr()(Jrossivacom
Bruce Goodman, M.D.
1515 North Front Strcet
Harrisburg, P ^ 17102
Our Insurcd
Claim Nwnber
Dale of Loss
Patient
Octavy 130unader
971062007
Dccember 17, 1998
Youssef Bounader
After careful review of the attached Peer Review, treatment will be reimbursed based on the
following:
..
"Treatment Is Appropriate
"Diagnostic Testing Is Appropriate
"Referrals To HealthSouth and Rehab Works Appropriate
"MMI Achieved by May 17, 1998 - ..-'"
Pursuant to Pennsylvania Act 6 of 1990, Section 1797, asstated in Chapter 69.52(H): "An
insurcd, provider, or insurer may request, in writing, reconsideration of the initial PRO
detennination within 30 days from the date the initial determination is effected. A PRO may set
a reasonable charge for a reconsideration but in no case shall the charge for a reconsideration
cxceed the charge for the initial review. An insurer shall make full payment of the charge for
reconsideration to the PRO, but-the amount paid for the reconsideration shall ultimately be borne
by the party against whom a reconsideration detenninalion is madc."
PROGRESSIVE
~v
e assl ,c ;\JCJlllahcl.
Cassi L. Ncwland
Medical Claims Reprcsentative
Enclosurc
cc: Handler &. Wiener
COll1mwlity General OSlcopalhic
Hartman Cannon Rehab Associates
Quantum Imaging &. Therapeutic
llcalthSoulh Rehah of Mcch:U1icsburg
UplO\\11 Cardiology Associatcs
Pinnaclc Health Hospital
lkbabworks INC
Tristan Associales
CentralPA MRI Center
EXHIBIT D
.
.....
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ICLAltkcllPrncc:ipe 10 Suhstitulc CounsclAugusl1 H, 19992: ) 7 I)M
YOUSSEF BOUNADER,
PLAINTIFF
IN THE COURT OF COMMONS PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
V.
NO. 99-2555 CIVIL
PROGRESSIVE INSURANCE COMPANY,
DEFENDANT
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
PRAECIPE TO SUBSTITUE COUNSEL
TO THE PROTHONOTARY:
Please substitute the undersigned counsel for thc Plaintiff in the above-refercnced action
and withdraw the appearance of Matthew S, Crosby, Esquirc, Handler, Henning and Rosenberg,
319 Market Street, P.O. Box 1177, Harrisburg, Pennsylvania 17108.
Respcctfully submitted,
S:\lIGEL, ANDERSON & SACKS
//"'"
Date: _&;_'-2/ J Cl? <I
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C. L > dcrson, Esquire
1.0. #: ,,1315
2917 North Fronl Slreet
Harrisburg, I' A I 7I 10
(717) 234-2401
o\:I(,"!1ey~ t:~r Pl2intif(
HANDLER, HENNING and
ROS ' RG
Date: f, (f- fJ____
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Malllew S. Crosby.
I.D. #. 69367
-' I', MarkcI Strcet
J larnsburg, PA 17108
(717) 23S-~O(lO
Altomcys fOI Piaintiff
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
BOUNADER
Vs.
NO. 992555
PROGRESSIVE INS CO
CERTIFICATE
PREREQUISITE TO SERVICE OF A SUBPOENA
PURSUANT TO RULE 4009.22
As a prerequisite to service of a subpoena(s) for documents and things
pursuant to Rule 4009.22 GEORGE FALLER, ESQUIRE certifies that:
1. A Notice of Intent to Serve the Subpoena (s) with a copy of
the subpoena(s) attached thereto was mailed or delivered to
each party at least twenty days prior to the date on which
the subpoena(s) is sought to be served,
2. A copy of the Notice of Intent, including the proposed
subpoena(s) is attached to this certificate,
3. No objection to the subpoena(s) has been received, and
4. The subpoena(s) which will be served is identical to
the subpoena(s) which is attached to the Notice of Intent
to Serve the Subpoena(s).
Date: 07/16/02
GEORGE FALLER, ESQUIRE
MARTS ON DEARDORFF WILLIAMS
TEN EAST HIGH STREET
CARLISLE, PA 17013
717-243-3341
ATTORNEY FOR DEFENDANT
INQUIRIES SHOULD BE ADDRESSED TOs
MEDICAL LEGAL REPRODUCTIONS, INC.
4940 DISSTON STREET
PHILADELPHIA PA 19135
(215) 335-3581
By: Aisha Hodge
~
' .....--------..
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File #: M288312
ADDENDUM TO SUBPOENA
BOUNADER
Va.
PROGRESSIVE INS CO
No, 992555
CUSTODIAN OF RECORDS FOR: LIBERTY INS CO
ANY AND ALL RECORDS, MEDICAL AND OR ACCIDENT CORRESPONDENCE, NOTES,
RECEIPTS, BILLS, ETC., AND ANY OTHER INFORMATION PERTAINING TO:
NAME: OCTAVY BOUNADER
ADDRESS: 4308 KOTA AVE HARRISBURG PA
MEDICAL BILLING REQUESTED
ANY AND ALL MEDICAL BILLS AND RECORDS INCLUDING BUT NOT LIMITED TO
THE PIP FILE REGARDING AN ACCIDENT DATED NOV 17, 2001,
ALL FEES MUST BE APPROVED PRIOR TO RECORDS BEING FORWARDED.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
RECORD CUSTODIAN - COMPLETE AND RETURN
[
J RECORDS ARE ATTACHED HERETO: I hereby certify as custodian of
records that, to the best of my knowledge, information and
belief all documents or things above mentioned have been produced.
[
J NO DOCUMENTS A VA/LADLE: I hereby certify that a thorough search
hus been made and that no record of the following documents have
been located (CHECK THE APPROPRIATE BOX) :
) RECORDS
) X-RAYS
PATIENT BILLING
RECORDS / XRAYS have been destroyed
Date
Author~zed s~gnature tor
LIBERTY INS CO
CUMBERLAND
M288312-01
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