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DAVID C. ATKINS, . IN THE COURT OF COMMON PLEAS
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Plaintiff . CUMBERLAND COUNTY, PENNSYLVANIA
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. NO. ct'" - d{ 004- C~J~
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v. .
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STATE AUTO INSURANCE . CIVIL ACTION - LAW
.
COMPANY, .
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Defendant . JURY TRIAL DEMANDED
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NOTrCII
YOU BAVB BBBN SUBD rN COURT. If you wish to defend against the
claims set forth in the followlng pages, you must take action
within twenty (20) days after this Complaint and Notice are
served, by entering a written appearance personally or by
attorney and filing in writing with the Court your defenses or
objections to the claims set forth against you. You are warned
that if you fail to do so the case may proceed without you and a
judgment may be entered against you by the Court without further
notice for any money claimed in the Complaint or for any other
claim or relief requested by the Plaintiff. You may lose money
or property or other rights important to you.
YOU SHOULD TAD THrS PAPIIR TO YOUR LAWYBR AT OHCII. J:I'
YOU DO HOT BAVB A LAWYIIR OR CAHHOT AJ'I'ORD 00, GO TO OR
TBLJlPBOO TJm Ol'l'rCII SBT I'ORTH BilLOW TO I'rHO OUT WBBRB
YOU CJUI GBT LOCAL BBLP.
COURT ADHrHrSTRATOR
cumberland county courthouse, tth I'loor
1 Courthouse square
Carlisle, PA 17013-3387
(717) UO-15200
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4.
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DAVID C. ATKINS,
plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO.
STATE AUTO INSURANCE
COMPANY,
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
Defendant
COMPLAINT
AND NOW, comes the plaintiff, David C. Atkins, by and
through his attorneys, Schmidt and Ronca, P.C., and respectfully
avers as follows:
1. The Plaintiff, David C. Atkins, is an adult individual
currently residing at 18 Maple Drive, Mechanicsburg, cumberland
county, Pennsylvania 17055.
2. The Defendant, state Auto Insurance Company, is a
corporation licensed to transact insurance business in
Pennsylvania with sales offices at various locations in the
Commonwealth of Pennsylvania and a local claims office in
cumberland County at 4900 Ritter Road, P.O. Box 2006,
Mechanicsburg, Cumberland County, Pennsylvania 17055.
3. By terms of an insurance policy issued to the
Plaintiff, David C. Atkins, and Michael F. Barns, d/b/a Spectron
Electrical Services, policy number 10-BAP-6 543 316, (Defendant
has a copy of the applicable insurance policy), provided first
party benefits coverage for the Plaintiff in accordance with the
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provision of the Pennsylvania Motor Vehicle Financial
Responsibility Act, 75 Pa.C.S. S 1702, ~~, and said policy
of insurance was in full force and effect on AUgust 24, 1992.
4. On August 24, 1992, the Plaintiff, David C. Atkins, was
operatinq a motor vehicle, insured by the Defendant, which was
struck by a motor vehicle beinq driven by Julia Beard.
5. As a result of the aforementioned accident, the
Plaintiff, David C. Atkins, suffered serious injuries which
include, but are not limited to, the followinq:
a. Fracture vertebrae in the lumbar area:
b. Pain in the lower back:
c. Irritation of the sciatic nerve radiatinq into
the left leq:
d. Weakness in both leqs:
e. Pain in the hips: and
f. Soreness in the cervical area.
6. As a result of the aforementioned accident, the
Plaintiff has been obliqed to received and underqo medical
attention and care and to expend various sums of money and incur
various medical expenses properly due an allowable under the
terms of said insurance policy.
7. Followinq the accident, the Plaintiff qave timely
notice to the Defendant of the accident.
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8. Plaintiff has continuously submitted reasonable proof
of the amount of loss and reasonable proof of the amount of
bills incurred.
9. The Defendant has continuously challenged the medical
bills and has made numerous attempts to establish a reasonable
basis for denial.
10. On or about August 4, 1993, the Defendant attempted
without good cause to schedule an independent medical exam for
the Plaintiff. (See letter dated AUgust 5, 1993, attached as
Exhibit "A".)
11. On or about AUgust 4, 1993, the Defendant notified
West Shore Psychological Service that it was submitting the
treatments that were provided to the Plaintiff to a peer review
organization for evaluation. (See letter dated August 4, 1993,
attached as Exhibit "B".)
12. On or about August 4, 1993, the Defendant notified
Douglas K. Sanderson, M.D., that it was submitting bills for the
treatments provided to the Plaintiff to a peer review
organization for evaluation. (See letter dated August 4, 1993,
attached as Exhibit "C".)
13. On or about August 10, 1993, Plaintiff's counsel,
Charles E. Schmidt, Jr., notified the Defendant that Dr.
Sanderson wanted an "opportunity to discuss" his treatment of
the Plaintiff with the reviewing physician. (See letter dated
August 10, 1993, attached as Exhibit "0".)
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14. On or about August 13, 1993, Plaintiff's counsel
requested from the Defendant the reason for the Plaintiff'S
treatments being "medically unnecessary". (See letter dated
August 13, 1993, attached as Exhibit "E".)
15. On or about October 26, 1993, Plaintiff's counsel
informed, via certified mail, that Defendant failea to comply
with the peer review regulations. (See letter dated October 26,
1993, attached as Exhibit "F".)
16. On or about November 16, 1993, John W. Lehman, M.D.,
performed a medical records review at the request of the
Defendant.
17. Dr. Lehman opined that the treatment provided by Dr.
Sanderson was not medically necessary in regards to the
Plaintiff's motor vehicle accident. (See medical review dated
November 16, 1993, attached as Exhibit "G".)
18. On or about November 30, 1993, the Defendant notified
West Shore Psychological Service and Douglas K. Sanderson, M.D.,
that based on the results of the peer review, it was denying
payment for any and all outstanding medical bills from either
provider. (See letter dated November 30, 1993, attached as
Exhibit "H".)
19. On or about December 3, 1993, Plaintiff's counsel,
Charles E. Schmidt, Jr., requested a reconsideration of the peer
review in writing. (See letter dated December 3, 1993, attached
as Exhibit "I".)
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20. According to the Defendant, a reconsideration was
requested on December 8, 1993. (See letter dated December 9,
1993, attached as Exhibit IIJII.)
21. The reconsideration was performed on February 7, 1994,
and the Defendant informed the plaintiff's counsel that it was
denying payments on February 24, 1994. (see letter dated
February 24, 1994, attached as Exhibit "K".)
22. To date, the Plaintiff owes outstanding bills that the
Plaintiff believes and avers are payable under the applicable
policy to Douglas K. Sanderson, M.D., and West Shore
Psychological Services in the amounts of Five Hundred ($500)
Dollars and Four Hundred Fifty ($450) Dollars respectively.
COUNT Y
DAVYD C. ATKINS V. STATB AUTO YNSURANCB COMPANY
J'IR8T PARTY BBNBI'ITS - BREACH OJ' CONTRACT
23. Paragraphs 1-22 are incorporated herein by reference
as if set forth in full.
24. It is believed and averred that the bills for West
Shore Psychological services were submitted to the peer review
more than ninety (90) days after receipt by the Defendant in
violation of The Department of Insurance Regulation Title 31 S
69.52(d).
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25. The initial determination was not completed within
thirty days after the Defendant referred the Plaintiff's case to
the peer review organization in violation of The Department of
Insurance Regulation Title 31 S 69.52(d).
26. The Defendant failed to notify the plaintiff of the
initial determination within five days after the Defendant
received the initial determination report in violation of The
Department of Insurance Regulation Title 31 S 69.52(e).
27. The Defendant never requested additional records or
reports from either West Shore Psychological services or Douglas
K. Sanderson, M.D., during the initial determination in
violation of The Department of Insurance Regulation Title 31 S
69.52(c).
28. The Plaintiff's medical providers were not given an
opportunity to discuss the Plaintiff's case with the peer review
organization prior to the initial determination in violation of
The Department of Insurance Regulation Title 31 S 69.52(c).
29. The initial determination of West Shore Psychological
services' treatments was not reviewed by a licensed practitioner
of like specialty in violation of The Department of Insurance
Regulation Title 31 S 69.52(f).
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30. The medical providers were not afforded an opportunity
to discuss the Plaintiff's case with the reviewer and submit
additional information after a reconsideration was requested in
violation of The Department of Insurance Regulation Title 31 I
69.S2(j).
31. The reconsideration was not completed within thirty
(30) days after receipt of all information necessary to perform
the reconsideration in violation of the Department of
Insurance's regulations, Title 31, 169.S2(1).
32. The Defendant failed to notify the Plaintiff of the
reconsideration determination within five (S) days of receipt in
violation of Title 31, 169.S2(1).
33. Despite the submission of proof and demand for
payment, the Defendant has not paid the Plaintiff's first party
benefits to which he is entitled under the policy of insurance,
nor has the Defendant committed itself to pay such benefits as
is contrary to the terms and conditions of the policy of
insurance and the Pennsylvania Motor Vehicle Financial
Responsibility Act.
34. The Defendant's denial of benefits is without
reasonable foundation and unreasonable.
3S. The Plaintiff has requested a timely reconsideration.
36. The Defendant denied payment of bills based on a
finding in a report that the treatments were not medically
necessary in regards to the Plaintiff's motor vehicle accident
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which is a determination of relatedness and outside the scope of
a 1 1797(b) peer review. ~ CUrrev v. Penn. Nat. Ins. Co., No.
823 S 1993 (C.C.P. Dauph. County March 9, 1994) (attached as
Exhibit "L").
37. In prosecuting this action, the Plaintiff has secured
the services of Schmidt and Ronca, P.C., as his attorneys and
has incurred attorney's fees at the reasonable rate of One
Hundred Fifty ($150) Dollars per hour.
WHEREFORE, the Plaintiff, David C. Atkins, respectfully
requests that this Honorable Court grant the following relief:
a. Award Plaintiff medical benefits plus interest at
twelve (12\) percent annum:
b. Award attorney's fees pursuant to 75 Pa.C.S.A.
11716 and 1 1798(a) based on actual hours
expended until the date of final judgment in this
matter: and
c. Award costs.
COUNT :n:
DAVID C. ATKINS V. STATE AUTO INSURAHCE COMPANY
B~ PAITB - SPECIAL DAMAGBS
42 Pa.C.S.A. 18371
38. Paragraphs 1-37 are incorporated herein by reference
as if set forth in full.
39. For all bills for services, the following additional
bad faith damages are requested, since they were incurred after
July 1, 1990.
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40. The Plaintiff believes and therefore avers that the
Defendant employed the peer review organization in bad faith and
that this particular peer review organization does a substantial
amount of peer review work for the Defendant and has a financial
interest in providing a biased peer review report to the
Defendant, therefore guaranteeing a satisfactory report to the
Defendant.
41. The Plaintiff believes and therefore avers that the
Defendant's refusal to pay first party benefits based upon a
peer review that was not completed within thirty (30) after
referral to the peer review, not forwarded to the insured within
five (5) days after receipt by the Defendant, never requested in
writing from the provider any additional records and documents
necessary to undertake the review, never provided the providers
an opportunity to discuss the case with the reviewer, never
provided the providers with an opportunity to submit additional
information to the reviewer, was not conducted by a licensed
practitioner in the same specialty for West Shore Psychological
Services, failed to provide the providers with an opportunity to
discuss this case with the reviewer upon reconsideration, and
has not paid the Plaintiff's benefits constitutes bad faith.
42. The Defendant has required the submission of multiple
formal proofs of claim.
43. The Defendant scheduling an independent medical
examination without good cause constitutes bad faith.
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44. As the sole and proximate result of the Defendant's
bad faith, the Plaintiff has lost the use of proceeds and was
forced to hire an attorney and incur attorney's fees.
WHEREFORE, the Plaintiff, David C. Atkins, respectfully
requests that this Honorable Court award a judgment against the
Defendant pursuant to 42 Pa.C.S.A. S 8371 for the followinq:
a. Interest at prime plus three (3') percent,
b. Punitive damaqes in excess of TWenty
Thousand ($20,000) Dollars,.. and
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c. Court costs and atto~ey'~ f es.
By:
Charles E. Schmidt, Jr.
Co-Counsel for Plaintiff
1.0. '19198
209 state street
Harrisburg, PA 17101
(717) 232-6300
By:
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Scott B. oop:r-
Co-Counsel for Plaintiff
1.0. '70242
209 State street
Harrisburg, PA 17101
(717) 232-6300
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. INTRfCORP
intracero
99 Novemoer Drive, SUite 301
Camp 'Jill. "A 17011
AugU::il 5 1993
Charles Scnmuil jr
Schmidt Be Monca
209 Stale SlTeel
Yarr!sourg. CA 17101
~e :avld Ati<:r.s
Ac:Ol.;~! :!a!~ ~Ic,' 9AP55J3~' e-AD
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....~ar ...ncrr.ey ~cnmlCI
: al1' a rehacliitatlcn scec:allst ana I have :Jeen asked oy Sher.-y Miller of Slate Auto ~nsl.:rar.ce
Comoanles to scnecuie an incependent Medic31 Examination ier your cliem David Atk:ns wltr
Dr ."'icnael ~..omac;1.
The exam!natlon is scheduled ior Weanesoay, Septemcer 15, 1993 at 3'30 ? M
Dr, i.lJClnaCCI IS iocated at 230 South Second Street
Wcr~ieysourg, OA HC43
ihe ;lhone :'lumber IS' (i17) 975-3337
?Iease notify your client of this appointment and crovice a recent medical repcrt from the
:reating physlc:an and all x-rays, MRls regarding the MV;. ~: 3/24192, !f v'r Atk:ns has a ;;rcclem
<eeclng :his a:oointment Cf has any questions regarding :r's examinatIOn, ;llease contact rne at
717-761-5544
Sincerely,
~fhii. ~~,e/ll.
:"'mda =e::ermar. R.~
~ehabllitat1o" Soec:s!lS1:
EXHIBIT B
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" \TE HIAOOUAATERS
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Cou'nCIwI. OhIO 432'8
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~STATE AUTO@)
~L{J INSURANCE COMPANIES
Eastern Office' 4900 Ritter Road' P.O. Box 2006 · Mechlnlcsburg, PI, 17055 · Phone: (717) 697.1121
August 4, 1993
West Shore psychological Service
445 Gettysburg Pike
Mechanicsburg, Pa, 17055
Our Insured
Our Claim No.:
Date of Loss :
Patient
David C, Atkins & Michael F. Barnes
6 543 316
8/24/92
David Atkins
Dear Medical Provider:
Pursuant to Section 1797 of Act 6 of 1990 (Motor Vehicle Financial
Responsibility Law, 75 PA, C.S. 1701. et seq, ).records of treatment, health
care services, products, and/or accannodations provided to the above indicated
person by you or your facility have been submitted to a peer review
organi::ation for evaluation, The purpose of the evaluation is to confirm that
such treatment, health care services, products, and/or accannodations conform
to the professional standards of perfo~ce and are medically necessary.
We will advise you of our position in this matter upon receipt of the peer
review report,
Sincerely,
Sherry Miller
Claims Representative
Eastern Office
SM/blk
cc: file
David C, Atkins
Schmidt & Ronca, P.C.
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EXHIBIT C
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~STATE AUTO@
Jc{] INSURANCE COMPANIES
Eastern Omce . 4900 Ritter Roed . P.O, Bolt 2006 . Mechen/caburg, Pe, 17055 · Phone: (717) 697.1121
August 4. 1993
Douqlas K. Sanderson. M,O,
205 Grandview Avenue
Camp Hill, Pa. 17011
OUr Insured
OUr Claim No. :
Date of Loss :
Patient
David C. Atkins & Michael F. Barnes
6 543 316
8/24/92
David Atkins
Dear Medical Provider:
Pursuant to Section 1797 of Act 6 of 1990 (Motor Vehicle Financial
Responsibility Law, 75 PA, C.S, 1701, et seq,), records of treatment. health
care services, products, and/or accommodations provided to the, above indicated
person by you or your facility have been submitted to a peer review
organization for evaluation. The purpose of the evaluation is to confirm that
such treatment, health care services, products, and/or accommodations conform
to the professional standards of performance and are medically necessary,
We will advise you of our position in this matter upon receipt of the peer
review report.
Sincerely,
Sherry Miller
Claims Representative
Eastern Office
SM/blk
cc: file
David C. Atkins
Schmidt & Ronca, P.C.
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EXHIBIT 0
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209 StAte Street
HArrisburg, PennsylVAniA I 71 0 t
7 t 7 I 232.6300
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Schmidt and Ronca PC
Attorneys and Counselors at Law
August 10, 1993
Ms. Sherry Miller
state Auto
Eastern Office
4900 Ritter Road, P.O. Box 2006
Mechanicsburq, PA 17055
RE: Your Insured:
Your Claim iI:
Date of Loss:
Patient :
David C. Atkins & Michael F. Barnes
6 543 316
8/24/92
David Atkins
Dear Ms. Miller:
Thank you for a copy of the letter dated August 4, 1993,
addressed to Dr. Sanderson concerninq a peer review. I would
appreciate it if you would please identify, in accordance with
the insurance regulations, the identity of the reviewinq
physician, so that Dr. Sanderson has an opportunity to discuss
his treatment of Mr. Atkins with him. Please provide that as
soon as possible.
Thank you.
Very trul~ yours,
: r I
S1:Y~ r:.~o~~ :
Charles E. Schm
Attorney at Law
CES/ncc
cc: David Atkins
Dr. Sanderson
P.C.
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EXHIBIT E
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Schmidt and Ronca PC
209 St.te Street
H.rrlsburs. Pennsylnnl. I 7 101
717 I 232.6300
Attorneys and Counselors at Law
August 13, 1993
Ms. Sherry Miller
State Auto
Eastern Office
4900 Ritter Road, P.O. Box 2006
Mechanicsburq, PA 17055
RE: Your Insured:
Your Claim II:
Date of Loss:
Patient
Dear Ms. Miller:
David C. Atkins & Michael F. Barnes
6 543 316
8/24/92
David Atkins
I am sendinq this letter as a follow-up to my recent letter to
you in reference to the pendinq peer review in the above matter.
The Commonwealth Court has held in the case of pennsvlvania
Medical Providers Association v. Foster, 613 A.2d 51 (1992), that
the threshold issue of whether a matter is "medically necessary"
for purposes of peer review must be interpreted in liqht of the
standards set forth in the federal statute establishinq peer
review of Medicare services. I would appreciate a brief letter
from either you or someone in your company settinq forth why you
feel this particular case is "medically necessary" for peer
review.. --
Thank you.
..
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Very truly yours,
strJrf. ~ RO~CA,
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Charles E. Schmidt, Jr.
Attorney at Law
CES/mq
cc: Mr. David Atkins
EXHIBIT F
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Schmidt and Ronca PC
209 Stolte Screet
Holrrlsburg, rennsylvanla 17 101
717 I 232,6300
Attorneys and Counselors at Law
via certified Mail
Return Reoeiot Reauested
October 26, 1993
Ms. Sherry Miller
State Auto
4900 Ritter Road, P.O. Box 2006
Mechanicsburg, PA 17055
RE: Your Insured:
Your Claim #:
Date of Loss:
Patient
David C. Atkins & Michael F. Barnes
6 543 316
8/24/92
David Atkins
Dear Ms. Miller:
I am sending this letter as a fOllow-up to a recent telephone
conversation which I had with my client. Dave revealed to me,
for the first time, that psychotherapy bills for treatment
related to the automobile accident have not been paid since last
April. David told me that he had called you and was told by you
that the bills were being submitted to a peer review. David also
advised me that some of the bills had been forwarded to state
Auto back in June of 1993.
I would like to know as counsel for Mr. Atkins, first of all, the
basis for this submission. Please be advised that the recent
case law suggests that good cause must be shown in accordance
with the good cause standard under the Social security Act.
Please provide this information.
Please provide a copy of the notification to the provider that
you were referring bills to a peer review organization. Did you
notify the provider of the review and did you identify the
reviewer? Please also provide me with the date when the bills
were referred to the peer review organization, along with the
date that they were received by you. Please also be advised that
Regulation 69.52(d) of the applicable Regulations of the
Department of Insurance requires that a determination be made
within thirty (30) days after receipt of supporting information.
Please also be advised that if you have referred any billings to
a peer review organization between thirty (30) and ninety (90)
days from the receipt of the billing with the sufficient
documentation, you must make payment of those bills. Please also
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Ms. Sherry Miller
October 26, 1993
Page Two
be advised that any bills submitted after ninety (90) days are
invalid.
I look forward to hearing from you within two (2) weeks from the
date of this letter providing me with the information which I
have requested. Enclosed you will find a first party benefits
authorization for this information.
Thank you.
:~ry tru~ours,
SCHMIDTY,ND RONct
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Charles E. Schmid
Attorney at Law
.C.
CESjmg
Enclosure.
cc: Mr. David Atkins
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.\tr!'MORIZATIO!l reR RE!L\SC: OF FtRS't' ?AAT'! 3E~~:t': :It.Z
't'O: MS. SHERR'! MILt-SR
STATE AUTO
4900 RITTER ROAO/?O. BOX 2006
MECHANICSBURG, ~A 17055
I:ROM: CHARLES E. SCHMIDT, JR.
'SCHMIDT ~~D RONCA, P.C.
209 STATE STREET
HARRISBURG, PA 17101
1~u a:a ne=ecy au~hQ~~:~~ and di=ec~ed :0 ~e~~: :~a
~a1a~sa o~ ~y anc~:a
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suc~ ot~e: ~e~son as ~e may ~U~~Q~i:e i~c~uci~q, ~U~ ti~ieec ~O,
all ~edi~~l =epQ=~s !~d ~9C==:S.
sy =aascns =~ :~e ~3C: :~a: sue~ i~~=~a:~on ~~a: you nave
ac-..:.s,,4 'S ~~n~I"a"-;!!l' -"" _5 v"u a-~ a~5~ -ac"es-a..l -.... __a..-
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5UC~ :~~:==a:~c~ as ==n~:cer.~~!: a~c =a~~es:a~ ~o~ ~o ~u=~ish any
=~ S~=~ i~~==~a:~:~ ~~ a~y ~::= :0 a~te~a, ~i:~ou~ ~=~:~an
.au':~c:":.:a:::.on.
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10/26/93
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EXHIBIT G
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N I:' Y - 1 rfOv 16 "'S3 lS:~6 JAii:r .:.:r;~e.
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Uti N W. LEHMAN, M.D.
P.O. BOX 416
141S SlxrH AVENue
BEAVER FALLS, PA 15010
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PHONE: 4U-043.71112
FAX: 412-843-71151
ORTHOPEDIC SURGERY
, AND SPORTS MEDICINE
NovembM '6. , 993
/01.4. JtJ.l/.U KJ.mbte
I-PRO
600 W. GeMlC1n.t"",n p.ut.e
S~e 300 i
7'.t!lm"u:th M4Il,,t.l.ng, PA '9462'
Dea..t M4. K.unbte:
"
RE: DAVID ATK.INS
FILE I: PE04255
Th~ ~ct.tc"'4ng .L.6 .u.,ocll.t ",~' :tha {:UIl. r'te.VJ.4W acne on .eha ctbolle
pa..Uvtt, Ddv.td AtJl.(.M, a..t lo'''i.L4 1t.z.Q.~.).:t.
MEDICAl. RECORDS REVIEW: ,jU- .the Jt.a.:".'tct", ",iUch ",au -<lubmU..t4et o.net
wh~ch h~ve been ~.teet on th4 ~~~ 4nd ~eeond pdge ~~ yo~ COVell.
tette1l. hAve been Aav~~d,
SUMM~RY: BaAed en AQv.(.ew o~ that .(.n~o~~~r.. I o~~e1l. t~
~eUor.o.l-UlQ op.l.nJ.Cf\ .4fL Jte,Met ,t", the ~!.tI1~t""M v"u. ha.'.'/. )tC,i-:.ed,
I . !t. ",cu.Cd. OQ my cp.(.n.l.",t tita-t .i:t...a (J./)plI.o(MA.a.t4. d.<A~n".o~ .t"
-<.nci~ca..te tM 4flJUJI..(./JA %:ha..t ~ .tu-),ta..l.nect a,~ Jt~u.U .,~ .th..L.6 17l0.tQ4
veMe.U. ~c~d.et1.ot l....,utd be I. J a. CL'n.,t~.l.cn "6 .te6,t kllQ.Q,: 2. I Cleu.t4
CUV4Ca.(. .4~fl: 3.; 4.cu:t.! l.,;w /;a.c~ -4.t't~.(.1l aM 4. I p"~'-"4I;te
a.U.i1.elt.gh. noot a~~nUe.tll vltot.l.Hed a. I~td C':I7'.,oJt444.l..,n ~,"o.~UJLe o~
L-r.
,Ve-4p.uc .tJU.4 171t.'!.1'1' 4 4fl.t4MJ.'.t.ten.t leg e~'1IPta.4n.U, ! do not 6-ee.t
'~ the...e ~ CJt!/ ,,-v.(.denccl .tha..t r,,(l, -u,aee.a 4u.4.;ta..Lnlld (\. 1l.U.flA.4.t,,-d
c!.l.4e OJ\. fta.et Cln a,gGJta.va..t.i.alt ~~ elM pite.e"~.t4n9 f-1I."btem4 o~ ..oCc1.Jt
t.l.64Ue. OA .ou..eta..(.l'1ad a.tlll ,tit/tire. ..toot J."'!(.I.Il.~, H.u. l'1e~".to9J.CI2.t
e.xam.(.na..Uon WaA MUtely I1"Jr.mat tJ...'l.Jl.I.ghou.:C the. eot.:U.ll.e COUJl4e. ,,~
.t.tea,tment ~",a: tll4 leg compl.a..(.nu 1IP"_te. It",t -oeV4JtQ o.r.d ",.ue
D(14.l.r:a.ttll .ol.l.bJe.c.t.tve.. I :to not ~ee.(. tlta.t h~ p,\e-u..t.ot.tnQ
h,U.tOJtIl "JI. p;uw.(.otW d-<.a.QflIl4.{...) "0. a. IteJl.ll~a:U.d d.{..6c 1t<!a.t.l.y .u cl
~a.~OJl, .(.n ~~ ma,n'4 ..ollmp.~"m4.
2 . It ",ordct be my "p..(.fl..(.O/l tha..t. .the .',IlJ...t{o.{ ~e.6-U.Jtd.I. .to tM
o.t.tho,oecU.e .6UJlpe.,,/t.4, 4pae,t~.te.cI.tJ..!/ 0.1.. L4PPe.. ",oa..o a.pPII.OPIl..l.a-to. 41ld
.\ecwo/Ul.bta ~"It a.n evMtt.u..~~"t MPer..JAUiI wUh the Que.4.t.to't~btll
"-M.Il o.-l.nd-l.ng4, It would b~ my ,~p).n..l.C/l. th4.t .the t;L~I7'~rt.t
Jr.e.nd4.\act b!l I)Jr.. L.l.ppe .l.tW~.u.Uil ~;(J..4 c:.ppJl.;3plL.ta,U I1I1d I 6-e.eL tha.t.
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M~, la-net 'u'mbu
RE: IM~'1D ArKHJS
f'a.ge 2
tna ~ec~nd ~~~~c~ v~~ 06 9'3~ ~'~ a.ceep~aQ~, Hvw~v~, beyond
that p~ln.t, I d~ n~.t ~Get thCL-~ ~~~e ~e~iJ.v ~ any naed ~~~
a.ctdJ..t.i."na.t ,tMa,tmQ,n.t eM a.11Y o.dC!;...u~I1a.t M~e,Vta..t4. The pa.t.Un.t
ha.d. a. t~t ,,~ .4u.b~Qc;t.i.va eO:n1ptcUflu ou..t ,'nae02d. h.e Itea.tty had. Vt2.Jt!(
~tte ~~ any P~4~~V& ~bJe~ve !~na~g4, When he wa.4 !~t
~eef\ by h~4 ~~t!l d"ct"~ the ctay ~~t~ h.~ acc~dent, It Wd4
n~ted th~ he had. a. ~utt Jtange ,,~ mo)t~en e~ h~ ~"W ba.c~ and had
n" .tettdeltlul..6.4. H~ neu.'totag.(..ca..<. eX(,I!rl.Lna.tl.on WerA 1l011Jlla.t. He then
devetoped. ~on~ l~~t te9 pa.~n beC4U4~ o~ h~ p~v.i.aU4 r~t~lty,a.nd
h.e WC!.4 Ae~e~Jted !,,~ eVa.(u~on t~ the e~aped.~c ~ur.Deo~, When
he. W<v.> -4Un 01\ 9 - I bIJ h.~ ~a.may a~ctolt a.lia.~n he compt4-<.ned. 06-
.o017l2 tew ba.c./t pa.~f\ ~().Q~ ac..tJ.llet!l but ~.ta.t2.d tha..t he wa..4 6eeUnp .
be.t.telt, AQa.llt I hAA eJta.?i<.n~lin W.1A w.l..tM.rt MMlO..t t.un.l...t-6, The.
f\4,)ta.Uon Wl1-6 tha.t. .th.e.ItQ WC!.4 no tendellJ?e.'4, TMlte Wa.4 MMttl.'
ltc1nge ,,~ matJ.an. S.tJta..t,~h.t.up ltaAA.lnSl wa..o M/tJ1n.t, The
neuJt"t.og,Lca.t exam wa.4 n)Jt/M.l., .4.t the :U.m"-, he wa..4 ~Un by the
~ltth"p4d..(.c. -4l.v..oe~M all 1 ~ 2, .u. Wl'l.~ Mted cn..tv .tha.t h.4 had ~"me
tandQ4n4~~ on the 1t~9ht to a~ep p~p~~n b~ the ne~~"t"g~ca.t
eX4llUna..UOtt and .6.tJta.(.9h..~ teg .'t~n9 k:a.-6 11I;.Ba.t.(,ve. It w~ flUted.
tha..t he t.o(lA 1.n. no.) a.Cu..tll d .AtiLa ~~ .
Beea((.~e ,,~ the q,ue.~a"lt 06- .I:ll/rr.ptom-:. a.nd !lu~.t.l.\m ,,~ a. ~1La.e.tu..'te,
em MRI wa..4 ultdU2d wh,Lcll r;~1!1 MI.U !Ill acc.cpta.bt~. TM MiH exam
:ad l1!)t II.~VQa.t a.n~ de 6J..1tJ..u. tlt'2.c..t(vteA "I: a.n!! a.cL:..te C!:J/.r~ a.nd. by
9 M 30 th~ na,ta,.t.(.011 ,e,ta..ted ~ha..t ~he (:la,:U.en.t :~~ "ee.t~r.~ bet.telt and,
Iteque.oted .tha..t he. Il.UU,'tl1 .t~ w"ltk, He. t.o:,.e /.l.+.4.J!.ted or. "O~
Ph.II~J.ca..t tMILa.P; JIIAt ~:).'t -:,,,m2. u:.('..J:c'~~eA a.Tld /."tJ1.eflSitr.e.fl~n.g wMelt.
c"utd be a.PPIt~P.v.tUJ2., ;' du 1t:J,t ~e:>...t, hOwll.valt. tha.t. a.r.!1
~.(,~n.(,t!-J..ea.n..t a.<idJ..t.(,oncU ~:Jl.e.,v.mar:.t It.1C,,{. nec.c.M~!{ be.~Ofl:! .tha..t PIJ.(,1'..t.
A~ 6-a.~ a4 a.~d~J."l1~t tJt.~en.t th~ r~ h~a. r wo~ct 4ta.~e
c.u1aqu-<.voca.U,1I ! d" Mot ~ ut tha..t .the tJtea.,~men,t ti'la..t w:t.t plLav.:.d.ed
b';/ OJt, Sande,'t-)M WM mec.~eC'.teil r,cce~..~rJ.It!l J..., )U~GaAd :t..,J "li..-~ m.JteJl.
I.-eh~e.ee accJ.delt.t J..f1.:UttJ....,'~, ! ~~et .t..'ltU. J.h.a aJ71::unt .:6- u.e:l.tmen..t
tha..t he. ILQceJ..ved ave."- .01.0 ch a.1t c,u~ndE,.:t Pol,l,~O~ 06- .e~m~ c.J<1A lloJ,t
mect.i.cClUII c.PP.\rJPIt"a...te dr.d. i..nclead ma.\I \VeU ha.ve. c."n..t't~ou.t.aa to)
thM J71Q.Il'., ong~~ng .ollmp,tor.v., b':l ~~'.(..ng .in..t,;, .~u,~h C!cta.U~ aA t" the
p~nt'~ b"or.~c.ha.nlcdt .~k~-up ~d ~he. ~4~d. ~~Jt ~et~ ~~~e~~men.t
,,~ c"mpta...lnu,.
r.t J.4 my Op.(,n..(,Ofl tho..t h.2 w.;u.ed .....a.\ie oeM 6-a..:~ bet..t..elt ,,~~ ttJ be pu~
onto a. v~g"l\\)U.6 .~.tIte.tc.MM a.na ~t.n.en.g.tJ;~lt~r'9 ~XR_'tC.t~~ PJt"~ltCIJII a,11d.
~o)t bdela "not" .the ma.ln..)t/tl2.Ml ,,~ ~c..t~,,'.(J"~M, The./te.:.IM cutcUnt!f
11" ev~denc.e "11 a.nv e~J.~~ar. tha.t tnelte ~;aA ~l1Y ~e~.(,"~
undeltt!l-Utg :nu..oeuto~kece.t2.l. plt"QtelJ'Vo> Q.nd. w.,a..te.ve.\ ~"H .t.(...o.~u.e
,l.nJwt.i.u .th4.t h~ ml91t.t h,-ve 4e.ce....veA ~JQ.M! m.trt,{J);a.t a..~ ev.(,ctenee.a bV
tdeJt. 06 a.nv .tel\cteltrte...o~ a.'let /:)1/ rot.? ~",~\.Ill a;:,t ~l<.t.t Jt.:l.ng.:: oJ';' moUon,
T" canUnUQ ~11 t.'Un the 'U1lv0.4ru; ,,~ IIl.!d.J..c.a..~ e.x.p",~l!"'/Z. iitc..t he ct~d. by
Pit, Sdnae.1l.40/l.. ! d.., nJt 6~p..t (,}11..0 a"plI.~pJl,i.a..te. 0.... lle~I'.A-'C1.ilIl',
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l'Ie,'1 '16 ~93 lS1!:e 1~E:t r:tl:I~E:-
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M4. 1/l1le.t K.f.mbl.e
RE: "AVID AT~INS
1-'<1.ge 3
1 c1UO ~et .th~ .the g,uao..t o';!.t"..u..~ .:-~ z!1.e f,J.ta..t.l.C,t /lad oUtJI..<.ng to
a.tt .thR. Chc1MG!.6 .tha..t WI~A~ n~.t.(,celt arld Il.?H~c.UI1' .them J.n. UIlIM ,to
-4ub.tte .to vell.!I .4lAo.tt.e ;~o V~Il.l/ pe,~ce,:;t'('bR.a aAe ll.ea.U!/ .)u.bJac;Uve
t&.lUlW.Mto9!1 .tha.t ha.ve l/eJl.#, tUUe mea,n.i.r.s "Il. J.nteJtpll.a.ta.tA.OI1 44 ;to
whe.thell. oJ!. not .th.ell.a .l..l' J.f\dee4 a.n!/ pJl.ebtem.o,
r a.t.4o de not ~e2.t ~h~: the pll.e4~AJ.ptJ."r. ~"il OJl..thopedJ.c OJl.
wa.(~"ng .4haU .(..() medJ.ca,Uy n4.eM4a..\V Oil. a.,ppr..epl',.l.tJ;t.e o.nd ~h"utct
not be .the Jl.2.I:lP"M.Lb.J.U.t!l 06- the .LM~,\(IJI~ CClAM.ell..
It .J.4 mv op-'nJ.cn .th~ the l',e~eJl.Il.~ ~e .the p~Vch"te9~t .(..() not
mad.l.~tll /l.eCe.46aA!/ 44 J!.e~c1..~d ,te h~ mete.\ veh.lc.tlJ. a.ce.Lden.t .
-UlJUIl..l.~. ThA.4 nWt d.J.d. not .ou..o.t<un "11" .ol.M."eu...o .J.njull.1I 44 I',MUU
~t h'{"() mo,toJt. vehJ.cl.e a.cc.(,ctan.t o.n.:t zhue .L4 nO -Uld.l.ca..t'('ofl. .the
.l.M..t.l.a..t. .tJteo...t~nt bfl hA..o -6a.rn-l.tll ctoc.tOIl. all. bll Zha .<.1't.i.U.a.t
oll..th.ope~.l.c 4UAgeOfl. .that thell.& ~~ c1ny P.4VChot"9J.Ca.l. .f.mPc1ct noJl.
one woutd 'tI~e.M.oc1ll.a!l e~ac.t U M Jle.4u.e.t "6- .th~ Cl.cc.iden.t. Any
p.oyeh~tog~e~t p~obt~ ,'4 n~d oJt. ~n!l nece~~~Y ~Ol', e.vun-4el.4nO. I
de "ot ~ee.e. cautct c'- eo,M.idelLll.:! r.'.:ad.LCa.t.tV r.ecG!.6',\Ua..t.ad bl( MA
motoA veh.l.cte ~ec~ae^t.
3, The t.f.m~ed PII."-,6C.Jl...l.f,t.<"n ctJtug" ~h.a..t :.,'elt~ .oub'M:..ted wUh .the
doe~n?~ol1, I ~ee~ ~le plLob~btv ~PP40pll.~e up .thn.ou9~ the end
"6- Sepumbu 06- /992.
4. A4 I ha.ve noted a/j,,)\'4.. U. ~ filii apJ.r:.J..o'l .tha.t he .ll.ea.c.hed h.L.4
1TU}(~ fTl/2.a.ica~ ~Il.ovan;an.t olJ .th~, er.d .:.6- Se"ulIlbllJl. ,,~ /992 a.nd I
do no,t; 64~t thM an!l ~ctc:.u..I,"n.u 1;M,o:t.tmettt ...-:w 'u.c~-4a..t!{ oel/on.d
tha..t po.J.n.t.
5, Thell.e ~ no ll.eM"n .to a..o.-.W113 a,'lll ,:e....m:J.r:.e.r..t Wa..(,I'../l'l2n.t 44
lI.G!.6utt o~ tha mot"lL ve.~~ a.C.c~ctll~t .l.nJ~~e.~. Th2.II.e wa4 no
.i.nJlJ)l.J.flA :thAt we.J.~ doe.wr.er..tect t.!U1.t ''''~ItQ. ~~r.':'o~ nOJL ...'.:w!ct "ne
ll~~c..t .to hava any ,o~.'lIu..t. .i.Q1..,c.-L,\.nal\~, He b~.(,ca..U!I ha.ct .606-t
t.l.Mua. ../..nJ~tJ.RA wh.l.ch. 4h"tl.td Il4.vG!. luc.u.d .{.n Co Jl.4t~ve..e.l{ -4h"""t
pelt.iod ,,~, ~~ w~oat a.~y 6-utw\a. pll."o(~m~,
Thc.n~ !Iou -6-"Jt. the JPPoltt'...n-',tlf .to fN,tuc':'r.a..t2. -UI tr.../..-'. p"-:G.1l. J;ev.L.el./
~M,Oee.6-6 w.(..tlt yeu. r -6- :.'~l'" ha.ve ;tn(! {ou,'l..the ,t qu"",t..:,,;n.u, ~~e do
not he~Ua.te to c.~,Lta.c.t me.
S -UlCeJte.t.y .
1~",""",. '.D.. ~"'.p"" ,,,,,,<on
SeMa Ce~.u" .(.n. c)II..tIt~~ 1Z.1~e. SUll.9~!I
EXHIBIT H
,
,
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. (
~STATE AUTO@
~c;J INSURANCE COMPANIES
~. . "n HEADQUARTERS
51' a.o.d &neI
C..owL 0tlI0 Q2'1
Eastern Office. 4900 Ritter Road. P,O. Box 2006 . Mechan'"burg, Pa, 17055 · Phone: (717) 697.1121
November 30, 1993
~ t.
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:
West Shore Psychological Service
445 Gettysburg Pike
Mechanicsburg. PA 17055
OUr Insured
David C, Atkins & Michael F, Barnes
DBA Spectron Electrical Services
10 6 543 316
8-24-92
David C, Atkins
OUr Claim No.:
Date of Loss
Patient
Dear West Shore Psychological Service:
Pursuant to Section 1797, Act 6, 1990 (Motor Vehicle Financial Responsibility
Law. 75 PA. C.S, 1701, et seq,). the above captioned file was referred to a
peer review organization (PRO) for review. You were previously notified of
this referral. We have now received the results of the peer review; a copy of
which is enclosed,
Based on the peer review. treatment was necessary fran August 24. 1992 to
September 30, 1992. Treatment beyond this date was determined to be
unnecessary for injuries sustained in the motor vehicle accident.
Under the terms of the above mention Act, "If it is determined by a PRO or
court that a provider has provided unnecessary medical treatment,..the
provider may not collect payment for the medically unnecessary treatment.
services, or merchandise",
State Auto Insurance is. therefore. denying payment of any and all outstanding
medical bills fran your office, If you would like a reconsideration of the
decision, please inform us in writing within 30 days of the date of this
letter. The cost of the reconsideration will be borne by the party against
whan the final determination is made.
Sincerely,
Sherry Miller, A.I.C.
Claims Representative
Eastern Branch Office
David C, Atkins
Schmidt & Ronca. P,C.
gc'
vcc;
SM: beh
Enclosure::
';T"II I~JlO
"'''l4hllAL l7'Of1.'Ol-IAIK".
_ -'''''.' A\.,;.\Ln
" ,
hL,,",lc Auh.1MOt\ILl
"',.,~J"l " '.':H""lcr
...}U."":
STAll: AlJTOllr~
IN5URA~y.,;r Co....Flt.NV
STATE AUTO NAT10NAl
INSUAANC:F COI.'NN\'
........
. , I
.~ STATE AUTO@
~CJ INSURANCE COMPANIES
'-0""'- 'ATE HEADOUARTERS
5' QtoICI~*"
ColYo.......or..o.3211i
Eastern Office' 4900 RItter Road' P,O. Box 2006 . Mechan/csburg, Pa. 17055 · Phone: (717) 697-1121
November 30. 1993
Douglas K. sanderson, M,D.
205 Grandview Avenue
Camp Hill, PA 17011
OUr IllSured
David C. Atkins & Michael F. Barnes
DBA Spectron Electrical Services
10 6 543 316
8-24-92
David C. Atkins
our Claim No.:
Date of Loss
Patient
Dear Dr. Sanderson:
Pursuant to Section 1797. Act 6, 1990 (Motor Vehicle Financial Responsibility
Law, 75 PA, C,S. 1701, et seq,), the above captioned file was referred to a
peer review organization (PRo) for review. You were previouslY notified of
this referral. We have now received the results of the peer review; a copy of
which is enclosed,
Based on the peer review, treatment was necessary fran August 24, 1992 to
September 30, 1992, Treatment beyond this date was determined to be
wmecessary for injuries sustained in the motor vehicl e accident.
Under the terms of the above mention Act. "! f it is determined by a PRO or
court that a provider has provided wmecessary medical treatment",the
provider may not collect payment for the medicall y wmecessary treatment,
services. or merchandise",
State Auto Insurance is, therefore, denying payment of any and all outstanding
medical bills fran your office, If you would like a reconsideration of the
decision. please inform us in writing within 30 days of the date of this
letter. The cost of the reconsideration will be borne by the party against
whan the final determination is made,
Sincerely.
Sherry Miller, A,I.C.
Claims Representative
Eastern Branch Office
cc:
.Arc :
David C. Atkins
Schmidt & Ronca, P,C,
SH:beh
Enclosures
:ca.1t- AU1C
r1t.aANCIAl COAPQRAUON
ST,lH "'-ute,
....0 t nTY MI(l('.~.
.,.. ~ . . 0..,'...' '-0 ~ ,...r " "
::."'11 AoJ'O....OB!l[
I.' ,I 'A:. ..' ~m.t'.rr
r.......\,.,
STATE AU1Qll~~
INSUAl"K;:f r:OUPA.fl"
(,TATE. j\U10t,"H0';.'
tNStJR'-NCF COV;"',
"
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16 ~-;:.3 lS.:~6 jt1lcLT h:I';~LE.
1:'1 . .... .
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\....jtlN W. LEHMAN, M.D.
P.O. eox 416
141S SIXTH AVENue
BEAVER FAl.LS. PA 15010
{,
PHONE: 41~.843.7812
FAX: 412-843-7851
ORTHOPEDIC SURGERY
, AND SPORTS MEDICINE
.,'t
Navembe4 '6. '993
J.l.6, ]t1J1.Q..t /(~te
I.PRO
600 W. GeJUl1I1l'l.t"",n P~e
S~e 300 i
P.t.!lmocdh M~l2.t.(.ng. PA /9462'
Dq.(I.Jl. M4. lambte:
'.
RE: DAVID ATKINS
FILE I: PEO'255
ThQ ~ott"",.(.nQ ,u JL~.oan..t o,~' :;he pUll. Ite v.lcw cione an .the a.balle
pa.t.l~. Oc1vU At.'l.vt.4, a.t lo'Olol.it ,t~Ii~.).t,
MEDICAL RECORDS REVIEW: ,~,U. .the ft.~c".'l.cl~ ,,,,r..lch "au .oubm.l..tUd. altd
wh~eh have been ~.ted on tha ~~~.t ~nd .oee"nd page ~~ youll. eOVe4
tet.tell. have b~ ~ev~~d.,
SUMMARY: SaAea on ~Qv~ew o~ tr~~ .(.n~",ur~~r., I O~~~1l. t~
~ottow.(.ng "p.(.n,.(.cn .(.n JLe~(l..td ,t.; the ~~~-:l.t.l."M v.:'u lI.a..:I. .Il.Coi.eed,
r, tot ",au.td. Q~ nil{ ",o.(,n.(,o't tita..t i:t..... CLPpn.Of)il,i.a..t4 d.u~fh).o~ .to
~ltci-i.c.a..te th2. .<.n.JUIl..(./Ul %hc..t flP., .tu,).ta..l.ne.d. a,.~ A~u.U; ,,0. t~ 17l".t~.."
veMe.U ac~ct.ett..e c.'culd be ,. J a CL'll.,'tLW.l.a'l ,,~ te6:t It'lu: 2, J 4C:u.te
CQItV.(.Ca.! ,4.t..\a...(,n: 3.; 4Cut.! t.;w I;a.c!? -4.t'ta.l.'l a.n.d 4, I p"-4~"I;.te
a.Lth."L:.9h no.t de~n.u..e.lll Vltlt.(,~.ted. Cl. mJ.t.:t C.:mp.o\4-644"n. 1l-'-"'~wte ,,~
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,De.o"4,t.c .thU /Ik....n..o .(,n.t~JU7l.L~en.t ie 9 cC:'7lPt<:Un.U, ! d" M.t 6eet
'~c..t .the4e ~ <tit!! ev.tdencI! .tfta..t r.e ,vlde.e.d 4u.4~nQd (\. 1t.aJl.n..<A.ted
c!.l..6c. "4 na.a an a.!;!;It:1Va..t.iOlt .,.,!. an!! p,te~e".\..:~<It' "Jt."bt~4 a..t .4CCIA
:U..6.oue. "IL -4~ta.J.'led a.tt!:J nlt:t\ie It""~ .!.ttjwr.'I' H.i..6 ttewtotag.lc.a.t
u,cun.l.na..Uon wa,., an.t.l.,te.t!f nlM.ma.t th.'tJugh,o!.l.t the. e.'\..U.Jte COl.Lll-4e. "-:I-
.tItea..tn:en.t a.nd. .eM. I./l.g c."mpta..l.n.t.4 IlIol.Ua l10t -oev4lte a.r.<t welte.
ba.4.l.r:a..ttV ,oubJecUve. I :!a not &eei tha.t h.iA p,'I.e-u.,uUnQ
h.Utoll.lI all. P,Ul,V.(,"~ d.(.agn..l4~ o~ (1 't2....f1~aUd d,\..6C lte.oA:ty ,u Cl.
~a.c.to~ ~n .thL4 ma.n'.o 4Wmp,~~n~,
2, l.t ",autd be my opJ.nJ.oll tha..t .tM ...,nJ--Uctt ~46-~-'!.Jtc1t .ta :t~
o....thopelUe .ol.Lllgeo/t.ll. .-opac.,t~~d.u.!f O:\., U,ppe. ,./a: a.f)VI'.'JP,t.uu.e and
iu~~ona.bt.e ~alt a.n eVcMI~~M oMpec.J.a.Uy ",Uh :tf' Qu~:t.L': ~a.bty
X-il.a.v HndJ.ng.-o, l.t "'autd b~ mil '~pb.J."n tha..t the :tA""a..trr..a,,.t
Jte.!ldQ..lect by OJ!, L.<.ppe .lrU.;~.u.UIJ ~,/(7.6 c.ppltopr.A.aUt .:nd I ~e~ II. t.l'la..t
r. '--'.'''"''',l' ',:~,-=,'_q;,'t!,. -. ,"r
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RE: M~'1D ATKINS
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tna ~eC~f\d o~~~ee v~~ c~ 9.J~ kd4 a.ecep~rJ.c~, H~WdV~. beyond
.th4.t po.ln.t, I do tt".t; ~Qet tita...~ tM".ll. ,\Q.c.l.U:I wM l1Jl!( f\tul.d. 6-0/1.
a.<tdJ.t-lIMa.t .tJt.ea..tJnQ.n.t 0.\ /lilY a.dc::!I..:U"I1~ ltC!.il1,vta.U, The pa.t..l#.1l.t
hAd. a. .eot ,,~ .4l.1.bJac.Uva ecntP.tcUl\U bu.t -i.ncI,e~d. he Itea.tt!l ha.d. V~!(
t.lt.tte ~6- a.ny P04~~V. obJe~ve 6-~n~~g6, When he W44 6-~t
.4een by h4.4 ~~ty d."ct,,~ the aa.!( ~6-t2A h.~ acc-ldent, 4t ~
noted tita.t he hdd. Q. ~utt Jtd1l9e. 06- moUor. o~ h.!A .tow ba.ck /11\11 hdd.
no .te1\<teltlle.6.4, H~ nel.l.,'tot"g.(.e<u eJC.Gl.'Il4n~Uon Wa..,Q nOIUlla.t. He. th#.1l
developed. .4"n~ t~6-.t te~ pa41\ beC4~~ o~ hJA p~V40~ t~t"ItY,a.nd.
he Wd4 lte6-e~/l.ed 6-0/1. eVa.(u~on .to the o,~oped4e .4UADe"~. When
he W~ .4een on 9./ b!( ~~ 6-4mi.ey ~"ctOIt a.~a.~n he compta~ned. 06-
40m2 tow bdc~ pa.~n .4UQJ~~.(.vety bu.t .4~t~d. tha.t he ~ 6ee~ng
bet.telt. AQa.~n I tu.6 exa.r..t:n:1.t.l.lin I<.'.M wUMn noMU.l. t.tm.U4, The
rwu,uon wa..o .(:hILt .t.ha1t4 l./(l.4 no .tl1natll.f!.e.~/", ThQ..'te WlL6 MMU.t.
itc1n9/i!. ,,~mo.t~"n., S.tJr.:l"l..~ht -ug Jt~,l.ng W;l,.O 1tO/tm2.t. The
ne.Wl."t"g,Lc<l.t eX4111 wa...6 IDItlM.t.. ,.(t the .tUn,,-, he W<l.4 ~/i!./i!.n by the.
IMthop4d.c..e 4w:.Deo~ Oil ~-2, U wQ.~ rt<Jted Crt.tv .tha..t h.4 had .<l"me
t4ndQ~~Q~4 o~ .the ~l9ht to d~/i!.p p~p~"n. b~ the ne~~"~o9~ea..e.
e.X4IlKflo..U01'l a.nd .6.tJr.a..(.~h.~ tll9 .'taAMn9 (,,;0.4 n~Ba..t~IJIl, I.t Wa4 noted
thlLt he (..~ 1.n no c1Cu.t~ d.~tu~~,
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Beea(~~e ,,~ the Qu~~tlon o~ .6!1~~tom~ and ~l.I.e.~Zlon 06 c1 ~Jtc.ct~t/i!.,
an MRI Wa.4 Oltct/i!.JtGl<t wlt,LC1t r:U!I weU. be acc.cp.ta.btt.. rhe. MiH ex.a.nl
:t~d n"t lLalJedt a.n~ d/i!.6-b1~U. ~Jt.~c..t(l,.ll,~ or. a/l!f a.ec.:.te ctJA~ and. by
'1- 30 the n.otc;.t~O'l ,e,ta..ted .t1u1..t th~ (:'a,.aen~ :.:M 6eet.(.n7 be..t.te.1t /1I\d
Jtaque4ted tha..t he Itetu,\ll .to "'vll.k., Ha "'~ .e.rA.Jl.ted on 4.:100
ph\l~-laa...t thuap!I JlUt ~:l,'" ~om:!. ex.c,J.c,~.e~ a.nd .IMenSitr.ell~M wMen
c"utd be a.PPltOPllA.tU4., ;' d" n:Jt ~e:>..t. Ml..r,.;.valt, tha.t. a.r.y
~.{.9n4Hec.n,t. a.a:d~,t~"na..(. ~:J\.e.(v.mert.t 14~ r.ec.e.M~!I beyo,,=! :tha..t ptJ.{.n.;t.
)~ 6dlt CA a.,jd.u~Crt~.e. .t.t..~en.t tJu:..t he. h.:lJ.. 1 w.:cdct -4tc..te
wto.ql.l.4VOec:l.U-y I d." not ~ .ae.!!. t(l,a,t ti'la .tJr.ea.,~n~n.t tha..t W~ p,'tov..:.de.d.
by 0/1., Sa.rtde,\401'l Wct,.6 mec,J.Cc:~eil r.E:ce~.~a.It!l l.ll, Jl.eSaAd .tJ "'1c:.~ m"trJJl.
I.:/i!.h.<.cta c1CC4de/1t .c..1'l}u.tt.l....~. I t~~z ;t.'uU; ~ha aJl1.;unt. .:6- ,-u.u.tmen.t
.tlta.t he. llecQ..lvaa ~V201, .<lL.ch an e,u~llcte..:t P\?,t,i."~ 0 6- .e-lme WM Il':.(;
.'1lect~ca.UIf a.PPMPIL4,ue ar.d -i.1lC!.ea~ mllV \ve-U /':c.va c",.~'t.(,ou.ua ,t"
.thM man' 4 ollg,,-lng 4\1mp.tor.v.. b':l a;~'~llg .(.n.t~ ,~u,:h ctc.ta.<<-~ aA .tv t.he
p~Il.t'.4 b~or.~~n"cllt ,~k~-up ~d ~he 1'l~~d 6~/I. .6el~ 1l~4e4-4men~
,,~ eompta..(.rtu.
It. ~ mv op~/l(."n :thc..t h.a w..:u~d Mile. oeM ~a,;L b~.t.t.e1L "H to be put
ott.to a. V~!;OIl.t.)~ .~.tJr.e.tcMM a.nc! -4t.n.e.ltg.tr.;'Itb:.g alGP_\c.l,~~ PIL"~ltanl d1ld
!fOt. bdCIa 4n.t>> the 1l'lC1A.1\~.tItQ(I.m "9 ::c.t.(,v-U'..4~,~, Theile ....ct,.6 C~lI.tcUllt.!f
Ill) e.v.Ld.Mce on Cl.It!:l eX4J7lI.."'~or. tit<:.t .tnClIt('. ~:aA ct,,!.I 6e.1t~0~
ul1.d.eltt.!I-Ut.9 ~cuto.4h.e.ce.e:\.t "..t"t:tem.~ o.nd w~a.te.VM 4"~t ~,~u.e
,~nJu~4e4 .t/'l4.t he!. m.l.gl1.t h:l.ve ltec.e.....ve4 lIJeJtC m.l.'l-Ulta.t a.~ eV4ae.nc~d b!:l
tacit 06 ctn!( t02.ndClltrte..64 ct'ld. .by r." 41OC..;.m a;:,t ~t~ ....,'tI1!:;'- v~ m"t...,:,'rt,
T" c"nUnu.e "II t..'Uh. .tJ1.e ,:IJII,~;4rt.t ,,~ 11~(t,a.ll.~ e.xp.:o'~1.1Il2 .tho..t he. 0.1.1 ''J
OIL, Sdnde./l.o6o,~, I d., nJ,t ~eltt MLO a."(NL';;PJr..w..t.e. "I'. neCC',Ma.-,','
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RE: OAVID ATKINS
1-'.z.~a 3
I dUO ~e.! tha..t .the. g,t4o.t a'e.tc.-U4 ,;,6- ~he r,j.ta..t.J."fl 1f..a6all.1l..{.ng .to
ell! ~he. chdnge4 th~ Wl~~~ n~.t.{.ce.d and ~~~.t.~ct4n' them 4n .t~~m4 .to
.oubtte. to 1IeJl.!( .ol.4ott.e ;~o V~ltll pe-Lc.e,:.t.J.b.e,a aAe. ltea..Uy .,ubJe.cU.ve
,UMWto.eo9!1 tha..t have 11M':! .t..l.tt.t.e. r.lQa.t\.Lf.g !)If. .J.ntuPItQ.ta,Uc)n d4 :to
whetheJt 011. not tlU!lI.e .{...) '.J.ndeed a.rty pJl.obtem4.
I dt.oO do not ~ee..t. .thaA: the plI.e4c~pt.J.Or. ~OJl. oJtthop~c 011.
wc.(~-<.n9 .oh044 .L.6 med.J.c/l,t.t.1I n'-ee4.oa..W o~ a.ppr.oPItJ..a.:t..e. a.nd .ehoJutct
Mt be .the M.4pOM.<.Q.i.U.tl/ 06- the .{.M14,\a..'IC~ CMM.e.Il..
It ~ mw op.{.n.{.on tha..t the lte~e.Il.r.~ ~o the p~~chcto9~t ~ not
mad.t.c.a.ttll 1tQ.cu.ol1A!I d4 lI.e~d/Ld to M-$ mo.to.\ ve.iUc.t.Q a.cc.Uie.n.t
.utJUIl..l.~, ThMl nlQJt d.M Mt .o~.tl:Un "nv ~elt.(.oc.w .l.njuJI.!I d4 lte.6uU
~~ h~ motoJl. veh.{.~e. dcc.t.ae~ ~n~ %hell.e 44 no .J.nd.J.Ca..t.J.on the
.l.nU.{.a..t. .tJI.ea..tmant by hA..o ~a;n..l.t.y <toceo", "" ow .tha .(.n~(I..t.
Oll.tltoPe.~.t.c .o,,^Qe.on tha.:t.. thelte ~d4 dny P.oVchoto9.{.cal. .{.mPd~ noJl.
one. would neee.6.oa.ItUy elC.pac.t U, cv. Ite.ou.e.t Oc. th~ a.cc..l.de.n.t, Any
p.o!lehoto9.{.ca.! Pitobt~ ,1& held OJ!. dny nec~~.u.y ~OA cvun~~t.(.no. I
dIJ not ~e.e.e. Q.outct b~ e"M.{..:!u4';! l7'.:acUca.t.e!l I~ecu4.u~d by M...o
moto~ vehA.c~e ~cc.t.a~~t,
3, The t.un~te.d pM..6cl!.-l.",t.l.oJn <tJtc.Lg.~ t/ta..t :.~elt~ .ouc,nU"..ted wU,h ;thQ.
d~cwmen?~on, I 6-eet ~le p^ob~btu ~PP~"PIt~ ~p ~\"u9n ;thQ. end
o~ SepulllbeJl. ,,~ I 992,
4 , A.o I helve ne.ted a.o"','l?. .u I.A n1if opJ.r.J..O'l tha.t he A.ea.c.hG!d h~
fJUx..(.mwn med~ca..t. ~mpll."vfl/J:an;: by .th~, er.d .;~ Se".t..2.mbelt 'J~ 1992 and I
do no,t 6eet tha..t ~ny o.ac:.u./.oll'u T.).,~tme.lt.t Lo.':1.4 rtecU:<la.w be!lcmd.
.tha.t. p"~n.t,
5, TheJte J..o 1\" Il.e~,'" t.:; .:!A~W113 Q.'\!I pe.lt1lUtter..t .un::a.~/f.:nen:t; d4
Il.~utt ,,~ ~ha mo.t~JI. veh.(.~ o.ac~de~t ~nJ~le~, The"li! ~ n"
~ni\.LJl.J.1Ul :thAt weJt~ dIJc.wr.er.i:e.d ,t.iUI.t '",~"e ~it.r.~,,:.l.4 nool r.".,w!.d one
e.;o:,r;ec..t .to h~v:z. a.nll ,oeJtmO,rter..t. ,(,1M~.\.7W.n.t;. He blU~Ca..U!I ha.d .I.l"6-.t
.t.l.4.oue .i.nJu..'I.IJM 1NhA.c.n ..:.hou.ed. ha,ve h!la.Uct -i.n ~ Jl.eta.t.t.ve..e.!/ .oholl.t
pell.J..od "il, t.<.ma wUh"u,t 0.'.11 6-u.t:....\e p""lJ(,Ilm.6.
Thank !IOU ~"J!. .the ';PPOIl.t..4fIJ.,tll .to> P.J..\u.c4Ja..t~ .Ln :tJt~~ pe~1t I;~V.uw
pll."ce.-6.l.l wU,h !I"U. I~ :fOIL ha.ve :lflll ,'u.'I.the.t qU02.,.t..:.,m.u. ~~e da
not he~.ua.te .to eOllotac.t. me,
S.utCt/Aety,
,~"'"'"". M.D.. ",.p..uc. $...,.0.
S"a..\<t CQ.~.ucl .(.n, Oit.th.o,:'e\1-ia Su"~oo.,,
EXHIBIT I
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Schmidt and Ronca PC
209 Stolte Street
H"rrlsburs. rennsylvanla 17 101
717 I 232.6300
via Certitied Mail
Return Reaeiat Reauested
Attorneys and Counselors at Law
December 3, 1993
Ms. Sherry Miller
STATE AUTO INSURANCE COMPANY
4900 Ritter Road
P.O. Box 2006
Mechanicsburq, PA 17055
RE: David C. Atkins & Michael F. Barnes
DBA Spectron Electrical Services
Your Claim #: 10 6 543 316
Date at Loss: 8/24/92
Patient Name: David C. Atkins
Dear Ms. Miller:
I am sendinq you this letter in response to receivinq a copy ot
Dr. Lehman's peer review dated November 16, 1993, under your
letter of November 30, 1993. I was not provided with the peer
review for the services rendered by West Shore Psycholoqical
Services of 445 Gettysburq Pike, Mechanicsburq, PA 17055. I
would appreciate if you would please send me the peer review for
psycholoqical services provided to Mr. Atkins. On behalf of Mr.
Atkins, I am requestinq that the peer review of both Dr.
Sanderson's treatment and West Shore Psycholoqical Services'
treatment be submitted for reconsideration in accordance with Act
6 at 1990, and the Department of Insurance Requlations enacted
pursuant thereto.
I also note that no response was ever torthcominq to my previous
letters to you at November 12, 1993, and October 26, 1993, in
which I requested the dates when West Shore Psycholoqical
Services' billinqs were submitted to you for payment. I would
appreciate if you would please identify the bills and the dates
that they were submitted tor West Shore Psycholoqical Services.
The only letter I see in your file tram West Shore Psycholoqical
Services is dated April 12, 1993. Assuminq that this date is
correct, it would appear that the peer review ot their services
was submitted more than ninety (90) days beyond the time when the
billinqs were actually received by you. Please be advised that
under the law, these billinqs must be paid in accordance with
Section 69.52(d) ot the Requlations at the Pennsylvania
Department of Insurance. Failure to follow the requlations may
expose State Auto to damaqes and attorney's fees under the
I'
if
"
;i
RECEIPT FOR CERTIFIED MAIL I
NO I.~U'AW'I: ,.........- -_. . . .110 wI,h to receive the .\
E R: 2 lor __ -, lollowlf19 ..rvlee. (10. .n .xu. II
M-.. _., _or
com~' lteml 3. and 4a · b. of thiI fonn 10 INt WI can 'M):
I Print your ....... ... .......oo ... ....... , 0 Add......'. Add.... 1l! I
I m thiS card to you. _piece or on the bKk 11 'pilCI' JjO
I: An'" "". I_to'" "....1... m . '.-nuinbor 2 0 R.l1rlctocl D.llv.ry !II
.. doe. not permit. .. themlllpilClbNwthl . I II
t: . Writ."RtwmRIUiptRequnttd on the.....w..dtlvendlnCllhlatl Coneutt lun.ltlt for ... a:
'ti ThlRItUmRtuiP1wi11ahowtowham i I
. 4a Arllele Numbe.
'~ .\
,S ..Type a: l
o Regllt.rod 0 Inau.OCI .1'1
IIiI Cor1Iflocl 00 ~~~m Roc.lpt 10' !II
o Exp.... Moll 15 ,
-
7, Dote 01 D.llv~ a.......... g I
;;. "/- 7 -.....) ,..,
8 Add.._'. Add.... IDnly II ~tocI t I
' end '" i. p.ldl ~ I
,
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Ms. Sherry Miller
December 3, 1993
Paqe Two
Financial Responsibility Law, and in addition, damaqes tor bad
faith pursuant to 42 Pa. C.S.A. S 8371.
"
Thank you tor your prompt attention to this matter.
Very truly yotn"s,
, i
SCHMIDT,ANDIRONCA, P.c.!
t:. /..~ 2, - ( r!
~..-"':"-~ ....,...>>-C~J;~
Charles E. Schmidt, Jr~
Attorney at Law
CES/mg
cc: Mr. David C. Atkins
Douglas K. Sanderson, M.D., P.C.
West Shore Psychological Services
P 422 468 227
~ I q
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I.
i
'.11. December 1991 fI U,8.QPO. 19'12-307-630
"
DOMEC;TIC RETURN RE^EIPT
~ _r'
Exhibit J
I
10RATE HEAOOUARTERS
. ...., Btad 51,..,
C41Umbul. Ohio U21S
If!f STATE AUTO~
Jc{] INSURANCE COMPANIES
Eastern omce . 4900 Ritter Road. P.O. Boll 2006 · Mechln/cabu'fl, PI, 17055 . Phon.: (717) 697.1121
December 9, 1993
Schmidt & Ronca, P.C.
209 State Street
Harrisburg, PA 17101
Attention: Charles E, SChmidt, Jr.
Our Insured
.
.
David C. Atkins & Michael P. Barnes DBA
Spectron Electrical Services
10-BAP-6 543 316
8-24-92
David C. Atkins
Our Claim No.:
Date of Loss
Your CHent
Dear Mr. Schmidt:
In regard to your letter of December 3, 1993 a reconsideration was requested
on December 8, 1993 on your behalf.
West Shore Psychological was paid on November 8, 1993 for services of April
20, 1993 through June 29, 1993. Enclosed is a copy of the I PRO summary.
Sincerely, '
0hL'vUJ 'rYk LCt, I
Sherry Mille~, AIC
Claims Representative
SM/pyc
Enclosure
""A'I: AUT'
. .......CIA<. '-C'RPOh" '
J~"Tt ,,0,
~"""'lR''t''NO~fQJ ."
;t~, ""~' .-r....I.'.
~ \. ~ , .~..'OHli.r
...u~ A ",'V~ANCL
C', """
~fr.'i'- .:urr
I~l')l. ,'j, ~j ~e cQt..."-
":":.'~ :~"'~';"f!~'IAl
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I
I-PRO
............................................................
Feedback or suggestions for improving I-PRO services
will gladly be received by Linda Burke, Auditing Supervisor
(215) 832-2929
............................................................
Date: November 16, 1993
Account: State Auto
Attn: Sherry Hiller
Address: ~900 Ritter Road
Hechanicsburg, PA 17055
Patient: David Atkins
Admitted/Discharged: 8/2~/92 - 9/6/93
Account File I: 1065~3316
Hospital/Provider: Dr. Douglas Sanderson &
Hultiple
Bill Amount: $2,339.02
I-PRO File I: PEO~255
Specialist: Janet Kimble, R. N.
(215).832-2929
SlIHHARY
DIAGNOSIS:
Contusion left knee, acute cervical and low back strain
DATE OF EVENT: August 2~, 1992
LINE OF COVERAGE: Auto No Fault
The claimant, David Atkins, is a 33 year old male who was involved in a motor vehicle
accident on B/2~/92. He was the restrained driver of an auto that struck another auto
broadside that had not stopped for a stop sign, He had complaints of left knee pain
following the motor vehicle aocident. He was seen at Hanover General Hospital where knee
x-rays were negative. He has a history of low back pain with a herniated disc and
subsequent surgery in 1989. He was referred to Orthopedic Surgeons and then changed care
to Dr. Sanderson, H. D. for unknown reasons.
The following documentation was submitted to a physioian reviewer for recommendations:
{
I-PRO
Final Report to Account: PBRICBR
Patient: David Atkins
Account File #: 106543316
I-PRO File #: PE04255
Page 2
1. Records from Shepherds town Family Practice
1. Office notes 12/5/90 - 7113/93
2. Consult report 9/4192 from orthopedic surgeons
3. X-ray reports 8/25/92 and 8/24/92
4. Billing 8/25/92 - 7/13/93
2. Records from Orthopedic Surgeons
1. Office notes 8/29/92 - 7/30/93
2. HRI report 9/16/92
3. Billing 9/2192 - 9/30/92
3. Records from D. K. Sanderson, H. D.
I; Of rice notes 10/9/92 - 916193
2. X-ray reports 8/24/92, 8/25/92, 9/16/92
3. Billing
4. Records of West Shore Psychological Assoc.
1. Narrative reports 1/25/93, 4/12/93, and 6/29/93 with billing.
5. Prescription receipts
Attached to this report is a copy of the peer review report for your perusal and records.
Based upon the report of the physician reviewer, I-PRO recommends that treatment be
allowed for Orthopedic Surgeons and Shepherds town Family Practice for the period of
treatment of 8/24/92 - 9/30/92, This treatment was necessary as a result of the motor
vehicle accident sustained injuries of 8/24/92. Treatment beyond this date was
determined to be not necessary as a result of the motor vehicle accident sustained
injuries.
Billing in this file is as follows:
1.
Shepherdstown Family Practice
8/25/92 and 9/1192
6/8/93 and 7/13/93
(no bills were received for
8/25/92 - 7/13/93 $147.00
$ 73.00 allowable
74.00 disallow
dates prior to 8/25/92)
tota 1
2. Orthopedic Surgeons - 9/2192 and 9/30/92 $148.00 - total bill, all allowable
3.
Or. Sanderson, H. D.
(of the $1,160.00,
review)
- 10/9/92 - 9127/93 $1160.00 - total bill, all disallow
$383.17 was already paid by State Auto prior to the peer
4. Pennsylvania Psychological Services - $840.00 _ disallow
the dates on the bills were illegible, but were noted to be for 1993, after the
HHI date set by the peer reviewer
5. Prescri~l.ion - Total $44.02 (9/21/92 - 5117193)
9/21/'l2 - t29. ~2 -, :lowable
Arter' 9/30, ',' - 'IIi, 'JO - d !sallow
A:l ~'low::iLJ :......! ...,,!t
r-ti,: "':i,lb~t (lno ':"~('(~:'\~"try :l;-", ., rr-~:Jult ')C '}1" mol'Jr vehicJf'
fl' ,....-.,}..,......'., ~.-~tilrrt"'" ~'.i~ d..ter~i:,.:..c1 ",n I,~. n.,t ne(' <-:.~ r','
:~I' j dr'....,. fll1~'.., -., . .. .,
I" ,
'Ill'
,- ,-, 'l_" ... J' '. 'l i.ll.
., 1: . "1 '.
,-.-.
I-PRO
Final Report to Account: PBR/CBR
Patient: David Atkins
Account File I: 106543316
I-PRO File I: PE04255
Page 3
Wan insurer, provider or insured may request, in writing, reconsideration or the initial
PRO deteNination witbin 30 days rro. the date the initial determ.nation is ertected.
Please submit any sucb requests tbrough the involved insurer.w
,.
~'.' ;-;....-......... j
."
(
I-PRO
Final Report to Acoount: PBR/CBR
Patient: David Atkins
Account File #: 106543316
I-PRO File #: PE04255
Page 4
Amount of Bill(s)
Less:
$2,339.02
Undocumented treatments/services
Duplioate treatments/services
Medically unnecessary treatments/services
$2,088.90
Charges above fair and reasonable/higher
than state-mandated
Charges unrelated to carrier's responSibility
Other
(TOTAL RECOHHENDED PAYMENT)
$ 250.12
$ 383.17
$ 133.05
$2,088.90
Less Previous Payments
for the opportunity to serve you in our cost-containment efforts.
1::t- /d;J/k.~.,
anet Kimble, R. N. ~
ud1ting Specialist ~
nclosures
Exhibit K
"
,.,'.., .".~
.
I
.POAAfe HEo\OOUAATERS
511 E... SroId S1tHC
COlumOuI on.o U21l!l
~STATE AUTO~
~c;J INSURANCE COMPANIES
Eastem Office. 4900 Ritter Road. P,O. Box 2006 . Mechlln/caburg, PIt, 17055 . Phone: (717) 697-1121
February 24, 1994
schmidt & Ronca, P.C.
209 state street
Harrisburg, PA 17101
Attn: Charles E. Schmidt, Jr,
our Insured :
David Atkins & Michael Barnes
DBA Spectron Electrical Services
10 6 543 316
8/24/92
David Atkins
our claim No,:
Date of Loss :
Client :
Dear Mr, Schmidt:
Pursuant to Section 1797, Act 6, 1990 (Hot or Vehicle Financial Responsibility
Law, 75 PA, C.S, 1701, et seq,), the above captioned file was referred to a
peer review organization (PRO) for reconsideration which you requested. We
have now received the results of the peer review; a copy of which is enclosed.
Under the terms of the above mention Act, "If it is determined by a PRO or
court that a provider has provided unnecessary medical treatment. , . the
provider may not collect payment for the medically unnecessary treatment,
services, or merchandise".
State Auto Insurance is, therefore, denying payment of any and all outstanding
medical bills for your client.
Sincerely,
" "'\
~t-L~( flU Lf1, 1
'Sherry Mil~r, AIC
Claims Representative
Eastern Branch Office
Enclosure
cc: David C. Atkins
cc: Douglas K, Sanderson, H.D.
cc: West Shore Psychological Service
SM/par
..,-
",
.~!
,
(
I-PRO
HOSPITAL BILL UVlEV
To
State Auto, 4900 Ritter Road, Mechanicsburg, PA 17055
Froll
315 S. Allen Street, Suite 425, State College, PA 16801
Auditing Specialist
Janet Killble, R.N.
Your PUe Number
106543316
Claill8nt Name
David Atkins
Adllitted/discharged
10/09/92
Hoapital
Dr. Uoaglas Sanderson West Share Psychological Services
SUllHAl.Y:
DIAGNOSIS: CONTUSION LEPT KNEE, CERVICAL AND LOW BACK STRAIN
DATE OF EVENT: AUGUST 24, 1992
LINE OF COVERAGE: AUTO NO PAULT
Attention 0
Sherry Miller
Phone
(814) 234-2728
I-PRO PUe No.
PE 04319
Report Date
02/11/94
Bill Amount
$2,000.00
The claimant, David Atkins, is a thirty-three year old I18le who was involved in
a motor vehicle accident on August 24, 1992. He was the restrained driver of
an auto that atruck another auto broadside while it had failed to stop for a
stop sign. He had complaints of left knee pain immediately follOWing the IIOtor
vehicle accident. He was seen at Hanover General Hospital where knee exrays
were negative but back xrays showed a questionable compression fracture.
The compression fracture diagnosis was unable to be confirmed with further
testing. He had complaints of low back pain with some radiation do~he left
leg. He has hie tory of back surgery in 1989. He was referred to Orthopedic
Surgeons and then Changed to Dr. Sanderson, M.D. for unknown reasons. He also
has received psychological services.
,
This review was conducted by a medicsl physician in the orthoped~:~pecialty
snd a psychOlogists as a requested reconsiderstion made from Mr. Atkins'
sttomey.
, . ,
(
I-PRO
Claimant Name : David Atkin8
Your File No. : 106543316
I-P10 File No.: PE 04319
Page 2
The following documentation was 8ubmitted to the physician reviewers for their
recomemndations:
1. Length of Treatment
2. Necessity of Treatment
3. Frequency of Treatment
4. Relatedness of Treatment to Injury
5. Diagn08is and/or Clinical Findings
6. Appropriatenesa of Treatment
7. X-ray Examinations and X-ray la-examinationa
8. (a) KHI Date
(b) Should any Permanent Impairment/Diaability be Anticipated?
Attached to this report is a copy of the peer reviewers reports for your
peru8al and records.
Based upon the report of the physician peer reviewers, IP10's recommendations
for Dr. Sanderson and West Shore Psychological remain unchanged from the
initial review that disallowed all services by these providers.
The reconsideration reviewer determined that care rendered by Dr. Sanderson was
excessive in leogth and was determined to be necessary aod appropriate until
October 5, 1992 when Dr. Lippe releaaed Mr. Atkins to return to work. The
psychological reviewer recommended the patient be evaluated for definitive
opinions could not be determined due to the vague and incomplete documentation
provided for review.
Provider verbal input was not requested by either provider and was not included
in thia review procesa.
"
,
(
I-PRO
Claimant Name : David Atkins
Your File No. : 106543316
I-PIO File No.: PB 04319
Page 3
PIlUL AXALtSIS:
Thank you for your referral. The following are the audit results as you
requested:
Total Hospital Bill Amount
Le..:
Accuracy:
Undocumented/Overcharges
Items not ordernd by a physician
Incorrect coding or DIG assignment
Mathematical errors
Personal iee..
Non-related:
Services/ite.. not applicable to coverage
Necasalty:
Unnecessary treatment/service
$2,000.00
$
$
$
$
$
$
$2,000.00
UCI:
Charges exceed fee schedule
Inappropriate provider or setting
Usual and customary issues
$
$
$
Other:
Total Deductions
$
Bquals:
Total Revbed B111
(total bill less total deductions)
Plus:
Unbilled charges/Underchsrges
$
$
Less:
Previous payment
$
Equals:
RECOMMENDBD REDUCTIONS
$2.000.00
'..,;..
(
I-PRO
Claimant Name : David Atkina
Your File No. : 106543316
I-PRO File No.: PE 04319
Page 4
"An insurer, provider or insured may request in writing, reconaideration of the
initial PRO determination within 30 daya from the date the initial
determination ia effected. Please submit any auch requesta through the
involved insurer."
Thank you for the opportunity to serve you in your coat-containment efforta.
Sincerely, ,
'\ D.M1t'r~,f,f/
JAnet Ximble, R.N. ~
Auditing Specialist
~
........................................................
Feedback of suggestions for improving I-PRO services will
gladly be received by Kathleen Egan, Auditing Hanager.
(814) 234-2728 '
........................................................
315 S. Allen Street, Suite 4:~. S~ate ColleRe, PA 16801
PbOD~ (814) Z34-~728
(
~
MEDICAL
REVIEV/.INC.
Commonwllllh 01 Penneylvanle Approved
Pitt Review Organiztllan
Ii
QUALITY ASSURANCE AND UTILIZATION REVIEW SERVICES
1':
[:
"
,!
"
j;
DATEI 92/97194
REQUESTED BYI JAnvt Ki.bl., R.N.
,
,.
i.
USMRMI 1811-INTRA
DOA/DOII 98/24/92
REFERENCE I DAVid Atkins
PRO CHART I
IMEI
RECORD REVIEWI
CAPACITY FORi'll
PEER REVIEWa
CLAIM-PRO I
RECONSIDERATION I O~thopedie
2ND OPINION:
ADDENDUM a
DISABILITYa
ADD/RECORDS:
DIAGNOSTIC:
FILEa Intueo~p
FILEM: PE04319
INSURANCE COa StAtv Auto
CLAIMM: 19-6543-316
DOB: 92/95/69
S.S.MI 164-56-5857
THANK YOU FOR CHOOSING US MEDICAL REVIEW FOR YOUR PRO CHART REVIEWS
AND INDEPENDENT MEDICAL EVALUATIONS. IF WE CAN BE OF ANY FURTHER
SERVICE TO YOU, PLEASE FEEL FREE TO CALL.
p,O, BOX 7137 . ELI<:NS PARK, "ENN:;{~VANI.\ 191 ~7
1215/635-34,14 . 3aO !J7B-44.;: . F~:' i215, 635-55::'
,
, . (
us MEDICAL
R E VI EW,INc.
..~mmonweallh 01 Pennsylvenia Approved
Pe.. ReView Orgenlzallon
QUALITY ASSURANCE AND UTILIZATION REVIEW SERVICES
February 7, 1994
RE: DAVID ATIINS
USHR I: l81l-INTRA
CLAIH I: 10-6543-316
DOA/DOI: 8/24/92
The following is a Peer Review of the data submitted regarding
the claimant, David Atkins. I bear in mind the date of accident
is 8/24/92.
RECORDS REVIEWED:
"Application for Benefits".
Notes from Douglas Sanderson, M.D., Orthopedic Surgeon.
Office notes from the office of Gary Schwartz, M.D.
Office notes from Ronald Lippe, M.D,.
Reports of Barry McClay, Psychologist,
Peer Review dated 11/16/93 by Dr. John W. Lehman, an Orthopedic
Surgeon.
DISCUSSION:
The "Application for Benefits" submitted by
includes among injuries listed "fractured
lumbar area". This diagnosis is not verified
of the material, His own physicians in fact
him as "fractured vertebrae".
the claimant
vertebrae in
in the review
did not treat
Notes from Dr, Douglas Sanderson, Orthopedic Surgeon, listed
him as being "excused from work activities" which is dated
10/9/92.
On 12/2/92 Dr, Sanderson ordered "a good pair of athletic
shoes for the support and shock absorbency".
In my opinion, these athletic shoes were not required.
p,o 3:;'" 71:>' . n ~ INS PARK PE'lcISYLV:.NIA '9' 17
::!~,. li)',~.\.o\4', . \';('-8~t.;.~,:,,'~ _ ....>;;:.:' ,~~;.,.~)~^~2
(
RE: DAVID ATlIHS
PAGE TWO
Review of the notes of Dr, Sanderson indicates that the
claimant was taken by ambulance to Hanover Hospital within
an hour after the collision.
I see no record of the Accident Ward. It would be of
interest to compare his Accident Ward complaints with the
patient's subsequent symptoms.
The records of Dr. Sanderson refer to the claimant having
had a herniated lumbar disc with a percutaneous diskectomy
performed in 1988, I see no clear statement to indicate the
extent of his recovery. It states simply that he "recovered
to the point that he could pursue reasonably normal
activities after several months", This is not a clear-cut
statement and is somewhat vague, Dr. Sanderson also refers
to the fact "on the most recent visit to his original
treating orthopedist he was advised to return the work".
He was also advised to "pursue a course of physical therapy
both of which he is not at this time",
The findings described by Dr. Sanderson in his initial
visits on 10/9/92 do not suggest a severe clinical picture.
Dr. Sanderson did not make a diagnosis of fracture of the
lumbar spine. He referred to "mild diffuse degenerative
changes but no evidence of acute bone or joint pathology".
He also reviewed an MRI of the lumbar spine which was said
to show scar from the area of his prior diskectomy. Dr,
Sanderson did not feel that he had "radicular origin for his
multiple problems". He suggested that he start a rehabili-
tation program.
A note on 10/29/92 indicates that there had been some
improvement and "today he had subtle to very subtle
difficulty", He also referred to "subtle to very subtle
left very subtle to extremely subtle right gluteal tender-
ness".
Vague findings are noted of a subjective nature in the note
by Dr, Sanderson dated 11/19/92, This also applies to the
notes by Dr, Sanderson dated 12/17/92 and 1/13/93. I
question whether the patient required additional treatment
through this period after October of 1992,
The same vague subjective complaints on 7/9/93.
This last note on 7/9/93 refers to "some family difficulty
lately and difficulty finding a babysitter and change of
residence and emotional agitation producing increasing
discomfort". I would conclude that a strong subjective
element is present here rather than objective findings,
(
RE: DAVID ATKINS
PAGE THREE
Notes from Dr. Sanderson continue through 8/6/93 and 9/93.
all of which suggest that much of the clinical picture is
subjective rather than objective. The same conclusions can
be drawn in the notes by Dr. Sanderson dated 10/1/93 and
11/1/93.
A note on 11/30/93 refers to regression and then states "I
once again pointed out to him that he had the knowledge if
he would use it more consistently", I find this very
unconvincing from the medical standpoint, A similar vague
note is included on 12/29/93.
X rays of the cervical and dorsal spine were reported on
8/25/92. Indefinite findings are referred here at Cl,
Apparently nothing more was done about that. The thoracic
spine was listed as being normal by X ray,
An MRI of the lumbar spine on
acute discrete disc herniation.
referable to the prior surgery.
9/16/92 showed no definite
The only changes noted were
He was seen by the physician on 8/25/92. the day after
the accident, This indicates that he had been wearing
seatbelts and was restrained when he went through an
intersection at 35 miles per hour. had the right of way
and ended up "broad-siding" another driver who went
through the intersection without stopping fully at the
stop sign,
The doctor indicates that he was seen on 8/25/92. the
day after the accident. He states "that he is better
today than yesterday". There was reference to the
prior operation for herniated disc in the lower lumbar
region with the surgery done by Dr. Harrison with
diskectomy. The patient "took about seven months to
heal" and had a prolonged course prior to that time
when he couldn't sit for years".
The note by the physician indicates that his neck
"occasionally cracks and pops but otherwise giving him
no problems". Range of motion of the back "appears
pretty normal and the patient does not appear to be any
acute pain or distress. The picture presented here is
very mild and this is shortly after the accident, He
was then referred to Dr. Lippe. At a subsequent date
was noted as having a left lower lobe pneumonia,
('
RE: DAVID ATlINS
PAGE FOUR
These office notes ar-e appar-ently fr-om the office of Dr,
Gar-y Schwar-tz and suggest that the clini~al pictur-e was mild
after the accident, The need for- continued tr-eatment is
ver-y doubtful!,
A r-epor-t was submitted by Dr, Lippe dated 9/4/92. He
examined him on 9/2/92 and he lists him as being healthy
appear-ing "in no acute distr-ess". His neur-ologic findings
were negative,
Subsequent office notes by Dr-, Lippe indicate that the
patient was having incr-eased pain in the lower extremity in
a phone call on 9/9/92, MRI was or-der-ed on 9/30/92 the MRI
was inter-preted as being "ver-y small herniated disc at L5Sl
but other-wise they ar-e nor-mal". This is contrary to the
inter-pr-etation by the radiologist. On examination Dr-. Lippe
recor-ds that "his straight leg raise test is negative and
his r-eflexes ar-e br-isk". Dr, Lippe concluded that he would
allow him to go back to wor-k on 10/5/92.
I have r-eviewed the repor-ts
psychological therapy, In
psychological ther-apy her-e is
of Bar-r-y McClay. who r-ender-ed
my opinion the need for-
extr-emely questionable.
I have car-efully r-eviewed the r-epor-t of Peer- Review dated
11/16/93 by Dr-. John W, Lehman, an Or-thopedic Sur-geon. I
am essentially in agr-eement with his var-ious conclusions and
inter-pr-etations of the mater-ial.
CONCLUSIONS:
1, In my opinion the length of tr-eatment given her-e
was excessive. It is my opinion that within four-
to six weeks after- accident. tr-eatment could been
discontinued. Much of the clinical pictur-e her-e
is subjective r-ather- than objective.
2, In my opinion the diagnoses based on subjective
complaints ar-e actually cer-vical and lumbar-
str-ain, The tr-eating physicians did not conclude
that he had a compr-ession fr-actur-e and in my
opinion, he did not r-equir-e the extended per-iod
of tr-eatment given her-e.
The many office notes by Dr-. Sander-son consist
largely of evaluations with "ver-y subtle" findings
of a subjective natur-e with little by way of
objective finding and with no specific tr-eatment
other than vague statements of "advanced
rehabilitation knowledge",
(
RE: DAVID ATlIHS
PAGE FIVE
3. In my opinion, no disability is anticipated here
and the treatment could have been discontinued at
the time when Dr. Lippe sent him back to work on
10/5/92,.
Essentially I agree with the points made by Dr,
Lehman in his Peer Review report.
The opinions rendered in this case are the opinions of the
reviewer. This review has been conducted without a medical
examination of the individual reviewed, The review is based on
documents provided to us by the provider with the assumption that
the diagnosis is true and correct, If more information becomes
available at a later date, this will be documented and reported,
Such information mayor may not change the opinions rendered in
this report, This report is a clinical assessment and opinion
conducted with the information available. It does not constitute
per se recommendations for specific claims or administrative
functions to be made or enforced,
,
Sincerely yours,
MAB/OS:DVT
I14.Jpv ~ J;!// /.("
M~IN A, BLAKER, M,D~~ / .
Board Certified Orthopedic Surgeon
-
~~~~~~,fIID
us Medical Rll/ilU1. I'/Ii:.
, .
-
Exhibit L
.
'28 December 1993 Argument Court
v.
) IN THE COURT OF COMMON PLEAS
: DAUPHIN COUNTY, PENNSYLVANIA
)
: NO. 823 S 1993
)
: CIVIL ACTION - LAW
)
I
I
SCOT'l' L. CURREY,
plaintiff
PENNSYLVANIA NATIONAL INSURANCE
COMPANY,
Defendant
BEFORE HORRISON, NATALB and. TORGEON, JJ.
OPINION
On May 24, 1991, the plaintiff, Scott L. currey, was
injured in a motor vehicle accident. At the time of the accident,
the plaintiff was insured under an automobile insurance policy
issued from the defendant, Pennsylvania National Insurance Company
("PNIC"). The insurance policy provided for first party benefits
pursuant to the Pennsylvania Motor Vehicle Financial Responsibility
Act, 75 Pa.C.S.A. ~ 1701 ~~, Plaintiff incurred expenses for
various medical treatments arising from the injuries he purportedly
sustained in the accident inclUding chiropractic care administered
by Robert o. Blake, D.C.
On March 23, 1992, PNIC sent notice to Dr. Blake that it
was exercising its rights to obtain a peer review of treatment
rendered by Dr. Blake. 75 Pa.C.S.A. ~1797(b). The peer review was
to be
performed
by Consolidated Rehabilitation
Company
("Consolidated"). Bya letter dated June 25, 1992, PNIC informed
Dr. Slake that Consolidated had concluded these treatments were
unnecessary and. that they were denying payments for services
1
.
.
.
rendered to the plaintiff from February 12, 1992 to the present.
The plaintiff, who was never informed that a peer review
of Dr. Blake's treatment was requested by PNIC and was not notified
that the peer review had been completed until August of 1992,
initiated this breach of contract action against PNIC for its
refusal to pay certain medical bills for treatment and testing
after the accident. PNIC has filed preliminary objections in the
nature of a demurrer contending that the plaintiff, by not
requesting a reconsideration of the peer review organization's
(PRO) decision, has failed to exhaust his administrative remedies
and therefore cannot bring this action to Court.
In rUling on preliminary objections in the nature of a
demurrer, all well-pleaded facts in the complaint and all
inferences reasonably deducted therefrom must be accepted as true.
wurth bv Wurth v. City of Philadelohia, 136 Pa, Commw. 629, 584
A.2d 403 (1990). "A demurrer will be sustained only when it
appears, with certainty that the law permits no recovery under the
allegations pleaded." Runski v. American Federation of state, 142
Pa. Commw. 662, 598 A.2d 347, 348 (1991).
The defendant asserts that the plaintiff has failed to
exhaust the peer review process as required by 75 Pa. C.S.A. S 1797
(b) . It contends that the Superior Court's recent decision in
Terminato v. pennsvlvania National Insurance Co., 422 Pa. Super.
92, 618 A.2d 1032 (1993), in which PNIC was a party, prohibits
the plaintiff's action as a matter of law. There, the Court held
that once the peer review process has been invoked, a party must
::
.
.
.
.
.
.
, ,
exhaust its statutory remedies before institutinq a court
.'
proceedinq. ~ at 1038. The defendant contends that by failinq
to request a reconsideration, the plaintiff has' accepted the
initial determination and must be bound by it.
When the leqislature enacted the 1990 amendments to the
Motor Vehicle Financial Responsibility Act, it created the peer
review plan to allow insurance carriers to challenqe the
reasonableness and necessity of medical treatments received by
insureds for injuries sustained in motor vehicle accidents. The
role of the PRO under this plan is to factually determine whether
a service or a product is medically necessary and whether it
conforms
to the
professional
standards
of
performance.
PennsYlvania ChiroDractic Federation v. Foster, 136 Pa. Commw. 465,
It
583 A.2d 844, 849 (1990). The PRO's decision is merely a fact-
findinq vehicle by which the General Assembly has implemented its
own policy decision to insulate insurers from payinq unnecessary
medical services. ~ at 477. Thus, the 1990 Amendments allow an
insurance company to use the peer review process only to review
medical bills that are questioned on the qround that the insured
either did not need the treatment or received treatment that did
not conform to medical standards, 75 Pa.C.S.A. 5 1797 (b) (1); ~
~, Henrv v. State Farm Mutual Automobile Ins. Co" No. 1647 of
1993, slip Ope at 3 (Alleqheny C.P. Oct. 1993).
Whether or not medical treatment is related to an
automobile accident is not an issue for a Section 1797 (b) review,
Probst v. State Farm Inc. Co., 112 Dauph. 400, 403 (1993) ("There
-'
i'
. .
.
.
.
is no suggestion [in the peer review plan] that PROs are authorized
. .
or even qualified to malee findings of [accident] relatedness");
Knox v. World Wide Ins. Groue, 140 P.L.J. 185 (C.P." Allegheny
1992). Consequently, challenges to the denial of claims, other
than those covered under! 1797, may still be litigated in the
courts withotlt use of the peer review process. 75 Pa.C.S.A. ! 1797
(b) (4).
The focus of the PRO's report issued by Dr. Emmans, was
that the treatment received by the plaintiff after February of 1992
from Dr. Blake was for injuries which were not accident-related,
but which pre-existed the accident. Dr. Emmans failed to address
whether the treatments were medically necessary, with the exception
of questioning why Dr. Blake needed a repeat MRI and EMG. Dr,
Emman's determinations, therefore, went not to whether the
t=eatments were necessary or conformed to the professional
standards of performance, but rather went to whether the injuries
were accident-related, with the possible exception of MRI and EMG
tests.
Therefore, we find that the determination of Dr. Emmans
was not one which was made according to the dictates of the peer
review process and plaintiff's failure to request a reconsideration
was not necessary. Therefore, the plaintiff has set forth a valid
cause of action against the defendant and accordingly, we enter the
following:
AND NOW, this
ORDER
.!1:!f:::: day of March,
1994, Defendant's
..
.
.'~,
.
.
.
. .
preliminary objections are hereby DENIED.
BY THE COURT:
'3
.
,!t,-r...~
ne TUrqeon,
Dlaerllluele.u
Glrald C. Kr...r, Esq. . ZD9 Selel Serlle, Hlrrllllurg, PA 17101
J.... G. NIIlon, Ill, Esq. . 3631 Nerch Frone Serlae, Nlrrllllurg, PA 17110
'In fh. c t..- Ie)
.
, '
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VERXPXCATXON BASED UPON PERSONAL KNOWLEDGE
AND XNPORMATXON OBTAXNBD THROUGH COUNSEL
X, David C. Atkins, verify that I am the Plaintiff in the
foregoing action and that the attached Complaint is based upon
information which has been gathered by my counsel in the
preparation of this lawsuit. The language of the complaint
to the extent that it is based upon information which I have
given to my counsel is true and correct to the best of my
knowledge, information and belief. To the extent that the
contents of the Complaint is that of counsel, I relied upon
counsel making this Verification.
I understand that intentional false statements herein are
subject to the penalties of 18 Pa.C.B.A. ~4904 relating to
unsworn falsifications to authorities.
Date:
f/S-/f(
I
tL/L?~
David C. Atkins
6;
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DAVID C. ATKINS,
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
.
.
.
.
.
.
v.
: NO. 94-2004 civil Term
.
.
STATE AUTO INSURANCE
COMPANY,
: CIVIL ACTION - LAW
.
.
Defendant
: JURY TRIAL DEMANDED
PLAIHTII'I"S RBSPONSB TO PRBLIMIImRY OBJBCTIONS
01' STATB AUTO
1. Admitted.
2. Admitted.
I. DBJIlJRRBR
3. Paragraph 3 does not require a responsive pleading.
4. Admitted.
5. Denied. It is denied that Plaintiff's claims are
barred by the Financial Responsibility Law, in that State Auto
failed to follow the requirements set forth in the Regulations of
the Pennsylvania Department of Insurance for submitting a claim
to peer review.
6. Denied. It is denied that Plaintiff's claim for bad
faith is barred or preempted, in that the Defendant failed to
follow the Regulations of the Pennsylvania Department of
Insurance for submitting a claim to peer review.
7. Paragraph 7 contains a conclusion of law which does
not require a responsive pleading.
-
r'" "--,-,'
,
8. Paragraph 8 contains a conclusion of law which does
not require a responsive pleading.
9. Denied. It is denied that Plaintiff's contractual
claim is barred by any peer review process, as such would
constitute a violation of the Financial Responsibility Law,
Department of Insurance Regulations, and the pennsylvania
constitution.
WHEREFORE, the Plaintiff requests that your Court dismiss
the Preliminary Objections of the Defendant.
II. PBTITION OF LACK OF JURISDICTION
10. Paragraph 10 does not require a responsive pleading.
11. Admitted.
12. Denied.
It is denied that Plaintiff's contractual
claim is barred by any peer review process, as such would
constitute a violation of the Financial Responsibility LaW,
Department of Insurance Regulations, and the Pennsylvania
Constitution.
;
ted,
, P.C.
By:
Charles E. Schmidt, Jr.
Attorney at Law
209 State Street
Harrisburg, PA 17101
Attorney I.D. '19198
(717) 232-6300
Attorney for the Plaintiff
,...~-...... ~
CBRTI.ICATB O. BBRVICB
AND NOW this
/31"-
day of May, 1994, I, Charles E.
Schmdit, Jr., Esquire, hereby certify that I have this day
served the foregoing Response to preliminary Objections of
state Auto, by depositing a copy of the same in the united
states Mail, postage Prepaid, at Harrisburg, Pennsylvania,
addressed to:
Douglas B. Marcella, Esquire
THOMAS, THOMAS & HAFER
305 North Front street, 6
P.O. Box 999
Harrisburg, PA 17108'
./-.,
~
By:
Charles E. Schmidt, Jr.
Attorney at Law
209 State Street
Harrisburg~ PA 17101
Attorney I.D. 119198
(717) 232-6300
Attorney for the plaintiff
,
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DAVID C. ATKINS,
Plaintiff
v.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PA
NO. 94-2004 CIVIL TERM
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
STATE AUTO INSURANCE COMPANY,
Defendant
NOTICE
You have been sued in Court. If you wish to defend against
the claims set forth in the following pages, you must take action
within twenty (20) days after this document is served, by entering
a written appearance personally, or by attorney, and filing in
writing with the Court, your defenses or objections to the claims
set forth against you. You are warned that if you fail to do so
the case may proceed without you and a judgment may be entered
against you by the Court, without further notice for any money
claimed or for any other claim or relief requested. You may lose
money or property or other rights important to you.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW:
Court Administrator
Cumberland County Courthouse, Fourth Floor
Carlisle, PA 17013
NOTICIA
Le han demandado a usted en la corte.
si usted quiere
defenderse de estas demandas expuestas en las paginas siguientes,
usted tiene viente (20) dias de plaza al partir de la fecha de la
demanda y Ie notificacion. Usted debe presentar una apariencia
escrita 0 en persona 0 par abogado y arachivar en la corte en forma
escrita sus defensas 0 sus objectiones alas demandas en contra de
su persona. Sea avisado que si usted no se defiende, la corte
tomara medidas y puede entrar una orden contra usted sin previou
aviso 0 notificacion y por eualquier queja 0 alivio que es pedido
en la petie ion de demanda.
Usted puede perder dinero 0 sus
propiedades 0 otros derechos importantes para usted.
LLEVE ESTA DEMANDA A UN ABODAGO 1MMED1ATAMENTE. S1 NO T1ENE
ABOGADO 0 S1 NO T1ENE EL D1NERO SUF1C1ENTE DE PAGAR TAL SERV1C10,
VAYA EN PERSONA 0 LLAME POR TELEFONO A LA OF1C1NA CUYA D1RECC10N SE
ENCUENTRA ESCR1TA ABAJO PARA AVER1GUAR DONDE SE PUEDE CONSEGU1ER
ASISTENC1A LEGAL.
Court Administrator
Cumberland County Courthouse, Fourth Floor
carlisle, PA 17013
THOMAS, THOMAS AND HAFER
By.
re
DAVID C. ATKINS, IN THE COURT OF COMMON PLEAS
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
v. NO. 94-2004 CIVIL TERM
CIVIL ACTION-LAW
STATE AUTO INSURANCE COMPANY, :
Defendant : JURY TRIAL DEMANDED
PRELIMINARY OBJECTIONS OF STATE AUTO INSURANCE COMPANY
1. Plaintiff has filed a Complaint seeking payment of
medical bills which they allege to be reasonable, necessary and
related to the motor vehicle accident, a copy of said Complaint
without exhibits is attached hereto and made a part hereof without
adopting the same as Exhibit "A".
2. Plaintiff alleges that on or about August 24, 1992, David
Atkins was driving a motor vehicle insured by Defendant which was
struck by a motor vehicle being driven by Julia Beard.
I. DEMURRER
3. Paragraphs 1 through 2 are incorporated herein and made
a part hereof as if set forth in full.
4. Count II of Plaintiff's complaint fails to state a fourth
cause of action for bad faith pursuant to 42 Pa.S.C.a. S 8371.
5. Plaintiff's claims of bad faith pursuant to 42 Pa.C.S.A.
S 8371 are barred or preempted of provisions of the Financial
Responsibility Act.
6. Plaintiff's claim for bad faith is barred or preempted by
the statutory and/or regulatory authority of Insurance Department
pursuant to or not limited to the Unfair Insurance Practices Act.
,
,
7. Plaintiff fails to state a cause of action for bad faith
for acts of Defendant.
8. The allegations of bad faith set forth in Plaintiff's
complaint fail to state a cause of action.
9.
Plaintiff's claims
are barred as
in Count I
reconsideration denied payment and Plaintiff has no basis for
action in court.
WHEREFORE, Defendant requests this Honorable Court to dismiss
Plaintiff's Complaint.
II. PETITION OF LACK OF JURISDICTION
10. Paragraphs 1 through 9 are incorporated herein and made
a part hereof.
11. The PRO and the reconsideration have both rejected
payment of Plaintiff's medical bills.
12. This Court lacks jurisdiction to review the decisions of
the PRO or its reconsideration,
WHEREFORE, Defendant requests this Honorable Court hold its
lacks jurisdiction over Plaintiff's action.
THOMAS, THOMAS & HAFER
DATED: ,N""
By \ ~
Douglas . Ma ella, Esqu re
305 No Front Street
P.O. Box 999
Harrisburg, PA 17108-0999
t
. ,'~l ," f>-/-",p,,,;',-, ,'.:.
CBRTIPICATB OP SBRVICB
On May 9, 1994, I, Cynthia D. Byrd, secretary in the law firm
of Thomas, Thomas & Hafer, hereby certify that I sent a true and
correct copy of the foregoing document to the following counsel of
record in the manner indicated below:
Charles E. Schmidt, Jr., Esquire
Schmidt & Ronca, P.C.
209 State Street
Harrisburg, PA 17101
~B~'~
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\
,
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
No.ql-~o04- ~~
DAVID C. ATKINS,
Plaintiff
v.
STATE AUTO INSURANCE
COMPANY,
CIVIL ACTION - LAW
.
.
Defendant
: JURY TRIAL DEMANDED
HOTze.
YOU HAVB BEEN SUED IN COURT. If you wish to defend aqainst the
claims set forth in the followinq paqes, you must take action
within twenty (20) days after this Complaint and Notice are
served, by enterinq a written appearance personally or by
attorney and filinq in writinq with the Court your defenses or
objections to the claims set forth aqainst you. You are warned
that if you fail to do so the case may proceed without you and a
judgment may be entered aqainst you by the Court without further
notice for any money claimed in the Complaint or for any other
claim or relief requested by the Plaintiff. You may lose money
or property or other riqhts important to you.
YOU SHOULD TAD THIS PAPBR TO YOUR LAWYER AT ONCE. II'
YOU DO NOT HAVB A LAWYER OR CANNOT AJ'FORD on, GO TO OR
TBLBPHon THE OFFICB SET FORTH BELOW TO I'IND OUT WBBRB
YOU CAN OET LOCAL HELP.
)
COURT ADMINISTRATOR
CUmberlan4 county Courthouse, 4th I'loor
1 Courthouse Square
carliSle, PA 17013-3387
(717) 240-1200
.,...
-
DAVID C. ATKINS, . IN '!'HE COURT OF COMMON PLEAS
.
Plaintiff . CUMBERLAND COUN'l'Y, PENNSYLVANIA
.
.
.
v. . NO.
.
.
.
STATE AU'l'O INSURANCE . CIVIL AC'l'ION - LAW
.
COMPANY , .
.
Defendant . JURY 'l'RIAL DEMANDED
.
COMPUIH'l'
AND NOW, comes the Plaintiff, David C. Atkins, by and
through his attorneys, Schmidt and Ronca, P.C., and respectfully
avers as follows:
1. The Plaintiff, David C. Atkins, is an adult individual
currently residing at 18 Maple Drive, Mechanicsburg, cumberland
County, Pennsylvania 17055.
2. The Defendant, state Auto Insurance Company, is a
corporation licensed to transact insurance business in
Pennsylvania with sales offices at various locations in the
Commonwealth of Pennsylvania and a local claims office in
cumberland County at 4900 Ritter Road, P.O. Box 2006,
Mechanicsburg, cumberland County, Pennsylvania 17055.
3. By terms of an insurance policy issued to the
Plaintiff, David C. Atkins, and Michael F. Barns, d/b/a Spectron
Electrical Services, policy number 10-BAP-6 543 316, (Defendant
has a copy of the applicable insurance policy), provided first
party benefits coverage for the Plaintiff in accordance with the
-
, rr'-~~t;;:;':!X~~4
provision of the Pennsylvania Motor Vehicle Financial
Responsibility Act, 7S Pa.C.S. S 1702, ~ ~, and said pOlicy
of insurance was in full force and effect on August 24, 1992.
4. On August 24, 1992, the Plaintiff, David C. Atkins, was
operating a motor vehicle, insur.ed by the Defendant, which was
struck by a motor vehicle being driven by Julia Beard.
5. As a result of the aforementioned accident, the
Plaintiff, David C. Atkins, suffered serious injuries which
include, but are not limited to, the following:
a. Fracture vertebrae in the lumbar area;
b. Pain in the lower back;
c. Irritation of the sciatic nerve radiating into
the left leg;
d. Weakness in both legs;
e. Pain in the hips; and
f. Soreness in the cervical area.
6. As a result of the aforementioned accident, the
Plaintiff has been obliged to received and undergo medical
attention and care and to expend various sums of money and incur
various medical expenses properly due an allowable under the
terms of said insurance policy.
7. Following the accident, the Plaintiff gave timely
notice to the Defendant of the accident.
2
8. Plaintiff has continuously submitted reasonable proof
of the amount of loss and reasonable proof of the amount of
bills incurred.
9. The Defendant has continuously challenged the medical
bills and has made numerous attempts to establish a reasonable
basis for denial.
10. On or about August 4, 1993, the Defendant attempted
without good cause to schedule an independent medical exam for
the Plaintiff. (See letter dated August 5, 1993, attached as
Exhibit "A".)
11. On or about August 4, 1993, the Defendant notified
West Shore Psychological Service that it was submitting the
treatments that were provided to the Plaintiff to a peer review
organization for evaluation. (See letter dated August 4, 1993,
attached as Exhibit "B".)
12. On or about August 4, 1993, the Defendant notified
Douglas K. Sanderson, M.D., that it was Submitting bills for the
treatments provided to the Plaintiff to a peer review
organization for evaluation. (See letter dated August 4, 1993,
attached as Exhibit "C".)
13. On or about August 10, 1993, Plaintiff's counsel,
Charles E. Schmidt, Jr., notified the Defendant that Dr.
Sanderson wanted an "opportunity to discuss" his treatment of
the Plaintiff with the reviewing physician. (See letter dated
August 10, 1993, attached as Exhibit "0".)
3
(.' ":..~........'-:'< ':!.2<'.":~'"
.-:'-:;
14. On or about August 13, 1993, Plaintiff's counsel
requested from the Defendant the reason for the Plaintiff'.
treatments being "medically unnecessary". (See letter dated
August 13, 1993, attached as Exhibit "E".)
15. On or about October 26, 1993, Plaintiff's counsel
informed, via certified mail, that Defendant failed to comply
with the peer review regulations. (See letter dated October 26,
1993, attached as Exhibit "F".)
16. On or about November 16, 1993, John W. Lehman, M.D.,
performed a medical records review at the request of the
Defendant.
17. Dr. Lehman opined that the treatment provided by Dr.
Sanderson was not medically necessary in regards to the
Plaintiff's motor vehicle accident. (See medical review dated
November 16, 1993, attached as Exhibit "G".)
18. On or about November 30, 1993, the Defendant 'notified
West Shore Psychological Service and Douglas K. Sanderson, M.D.,
that based on the results of the peer review, it was denying
payment for any and all outstanding medical bills from either
provider. (See letter dated November 30, 1993, attached as
Exhibit "H".)
19. On or about December 3, 1993, Plaintiff's counsel,
Charles E. Schmidt, Jr., requested a reconsideration of the peer
review in writing. (See letter dated December 3, 1993, attached
as Exhibit "I".)
4
,..:..
20. According to the Defendant, a reconsideration was
requested on December 8, 1993. (See letter dated December 9,
1993, attached as Exhibit "J".)
21. The reconsideration was performed on February 7, 1994,
and the Defendant informed the Plaintiff's counsel that it was
denying payments on February 24, 1994. (See letter dated
February 24, 1994, attached as Exhibit "K".)
22. To date, the Plaintiff owes outstanding bills that the
Plaintiff believes and avers are payable under the applicable
policy to Douglas K. Sanderson, M.D., and West Shore
Psychological Services in the amounts of Five Hundred ($500)
Dollars and Four Hundred Fifty ($450) Dollars respectively.
comrr I
DAVID C. ATKINS V. STATZ AU'l'O :J:NBtJRANCZ COMPAlIY
I'IRST PARTY BBNBI'ITS - BREACH 01' CONTRACT
23. Paragraphs 1-22 are incorporated herein by reference
as if set forth in full.
24. It is believed and averred that the bills for West
Shore Psychological Services were submitted to the peer review
more than ninety (90) days after receipt by the Defendant in
violation of The Department of Insurance Regulation Title 31 S
69.52(d).
5
'0....... ......_
.
25. The initial determination was not completed within
thirty days after the Defendant referred the Plaintiff's case to
the peer review organization in violation of The Department of
Insurance Regulation Title 31 S 69.S2(d).
26. The Defendant failed to notify the Plaintiff of the
initial determination within five days after the Defendant
received the initial determination report in violation of The
Department of Insurance Regulation Title 31 S 69.52(e).
27. The Defendant never requested additional records or
reports from either West Shore Psychological Services or Douglas
K. Sanderson, M.D., during the initial determination in
violation of The Department of Insurance Regulation Title 31 S
69.S2(c).
28. The Plaintiff's medical providers were not given an
opportunity to discuss the Plaintiff's case with the peer review
organization prior to the initial determination in viol'ation of
The Department of Insurance Regulation Title 31 S 69.52(C).
29. The initial determination of West Shore Psychological
Services' treatments was not reviewed by a licensed practitioner
of like specialty in violation of The Department of Insurance
Regulation Title 31 S 69.52(f).
6
30. The medical providers were not afforded an opportunity
to discuss the Plaintiff's case with the reviewer and submit
additional information after a reconsideration was requested in
violation of The Department of Insurance Regulation Title 31 S
69.S2(j).
31. The reconsideration was not completed within thirty
(30) days after receipt of all information necessary to perform
the reconsideration in violation of the Department of
Insurance's regulations, Title 31, S 69.52(1).
32. The Defendant failed to notify the Plaintiff of the
reconsideration determination within five (5) days of receipt in
violation of Title 31, S 69.52(1).
33. Despite the submission of proof and demand for
payment, the Defendant has not paid the Plaintiff's first party
benefits to which he is entitled under the policy of insurance,
nor has the Defendant committed itself to pay such benefits as
is contrary to the terms and conditions of the policy of
insurance and the Pennsylvania Motor Vehicle Financial
Responsibility Act.
34. The Defendant's denial of benefits is without
reasonable foundation and unreasonable.
35. The Plaintiff has requested a timely reconsideration.
36. The Defendant denied payment of bills based on a
finding in a report that the treatments were not medically
necessary in regards to the Plaintiff's motor vehicle accident
7
,.''''- -.:)-''''~
~..~.:;;;~
which is a determination of relatedness and outside the scope of
a 1 1797(b) peer review. ~ CUrrev v. Penn. Nat. Ins. Co., No.
S23 S 1993 (C.C.P. Dauph. County March 9, 1994) (attached as
Exhibit "L").
37. In prosecuting this action, the Plaintiff has secured
the services of Schmidt and Ronca, P.C., as his attorneys and
has incurred attorney's fees at the reasonable rate of One
Hundred Fifty ($150) Dollars per hour.
WHEREFORE, the Plaintiff, David C. Atkins, respectfully
requests that this Honorable Court grant the following relief:
a. Award Plaintiff medical benefits plus interest at
twelve (12%) percent annum;
b. Award attorney's fees pursuant to 75 Pa.C.S.A.
11716 and 1 1798(a) based on actual hours
expended until the date of final judgment in this
matter; and
c. Award costs.
COUNT :r:r
DAVID C. ATKINS V. STATB AUTO ZNSURANCB COMPAlIY
BAD I'AITB - SPBCZAL DAMAGBS
42 Pa.C.S.A. 18371
38. Paragraphs 1-37 are incorporated herein by reference
as if set forth in full.
39. For all bills for services, the following additional
bad faith damages are requested, since they were incurred after
July 1, 1990.
8
..
(.' ,.....
.
40. The Plaintiff believes and therefore avers that the
Defendant employed the peer review organization in bad faith and
that this particular peer review organization does a substantial
amount of peer review work for the Defendant and has a financial
interest in providing a biased peer review report to the
Defendant, therefore guaranteeing a satisfactory report to the
Defendant.
41. The Plaintiff believes and therefore avers that the
Defendant's refusal to pay first party benefits based upon a
peer review that was not completed within thirty (30) after
referral to the peer review, not forwarded to the insured within
five (5) days after receipt by the Defendant, never requested in
writing from the provider any additional records and documents
necessary to undertake the review, never provided the providers
an opportunity to discuss the case with the reviewer, never
provided the providers with an opportunity to submit additional
information to the reviewer, was not conducted by a licensed
practitioner in the same specialty for West Shore Psychological
Services, failed to provide the providers with an opportunity to
discuss this case with the reviewer upon reconsideration, and
has not paid the Plaintiff's benefits constitutes bad faith.
42. The Defendant has required the submission of multiple
formal proofs of claim.
43. The Defendant scheduling an independent medical
examination without good cause constitutes bad faith.
9
...'"'--
, ",'0'1
.
44. As the sole and proximate result of the Defendant'.
bad faith, the Plaintiff has lost the use of proceeds and was
forced to hire an attorney and incur attorney's fees.
WHEREFORE, the Plaintiff, David C. Atkins, respectfully
requests that this Honorable Court award a jUdgment against the
Defendant pursuant to 42 Pa.C.S.A. I S371 for the following:
a. Interest at prime plus three (3t) percent;
b. Punitive damages in excess of Twenty
Thousand ($20,000) Dollars~.and
c. Court costs and
-..l~' .? .. -
By:
Charles E. Schmidt, Jr.
Co-Counsel for Plaintiff
I.D. 119198
209 State Street
Harrisburg, PA . 17101
(717) 232-6300
By:
4~ ~ r:~./
Scott B. oope
Co-Counsel for Plaintiff
I.D. '70242
209 state Street
Harrisburg, PA 17101
(717) 232-6300
10
SHERIFF'S RETURN
ca+1ONWEI\L'lll OF PENNSYLVANIA I
COONl'Y OF ClMBERLAND
In The Court of Common Pleas of
Cumberland County, Pennsylvania
No. 94-2004 Civil Term
Complaint in Civil Action Law
and Notice
David C. Atkins
VS
State Auto Insurance Company
J. Michael Ick~R
, ~Rj()(ID(Reputy Sheriff of
CUnberland County, Pennsylvania, who being duly sworn according to law. says.
that he served the within ComplAint in Civil A",tinn L",w Ann NnH..."
upon Sta te Au to InsurAnce Company , the defendant, at q. d n
0' clock
A.M. E)!$JfX1 EDST, on the 21
day of
Apri 1
, 19....Q4B t
4900 Ritter Road. Mechani",,,hllrll
, CUnberland County.
Pennsylvania, by handing to Brllc~ Fi"hpr. S"ninr C'l",imQ M"'n"'9"'" ..~
State Auto Insurance Company
a true and attested copy of the Complaint in Civil A",Hnn r.RW "'nn NnH.....
and at the same time directing his
attention to the contents thereof and
the "Notice to Plead" endorsed thereon.
Sheriff's Costs:
Docketing
Service
Affidavit
Surcharge
So answers I
14.00
7.84
r~~~<:~~
R. Thanas Kline, Sheriff
2.00
23.84 Pd. by Atty.
4-22-94
by
~
P- ~(~ir f (J./~
'/Deputy Sheriff
Sworn dlld subscribed to before me
this :1S~
day of
!;f~~ -p
19 q'l A.D.
-
C},u- 0_ 'Jlw.L . ~.
Prothonotary
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PRAECIPE FOR LISTING CASE FOR ARGUMENT
(Mult bl typewrlt1en end lubmltted In dupllcete'
TO THE PROTHONOTARY OF CUMBERLAND COUNTY:
Pl.... U.llh. within m.llor lor th. nIXI:
.1L-
p...Tri.1 Argum.nl Court
Argum.nl Court
CAPTION OF CASE:
(.nll.. c.pllon mu.t b. .1.I.d In lulll
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IN THE COURT OF COMMON PLEAS
CUMBERLANO COUNTY. PA
NO. 94-2004 CIVIL TERM
-
c..c
.s;:...
DAVID C. ATKINS.
PI.lnti"
STATE AUTO INSURANCE COMPANY,
D.f.nd.nt
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
No. 94-2004
Civil Term
1994_
1. SI.t. m.llor to b. .rgu.d (I.... pl.lntilf'. malion lor n.w trl.l.
defendant', demurrer to complaint, etc.t:
C.I.nd.nl'. Pr.limin.ry Obj.clion.
2. Id.nllfy coun..1 who will argue ca.a:
(al lor plelnlllf:
Ch.,I.. E. Schmidt. Jr.. 209 Stel. St...I. Harri.burg. PA 17101
(bl lor del.ndent:
Dougl.. B. M.rc.Uo. P.O. Box 999, Herri.burg. PA 1710B
3. I will notify eU partl.. In writing wilhin Iwo d.ya Ih.t Ihl. c... he. b.en
1i.I.d lor .rgumenl.
-\~~~O?
(Allom.y or .n an
Daled: Jun. 17. 1 994
.
-
.~. .' ,-.._~
',.__-,._~h' ''''..';'''~''{' ;.,,'T)':~;;
'.~'_~.'-":d',. -i""
DAVID C. ATKINS,
Plaintiff
vs.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
94-2004 CIVIL TERM
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
STATE AUTO INSURANCE CO.
Defcndant
IN RE: DEFENDANT'S PRELIMINARY OBJECTIONS
BEFORE BAYLEY AND HESS. JJ.
ORDER
AND NOW, this
0*
7 day of August, 1994, aftcr argumcnt thcrcon and carcful
consideration thcreof, the prcliminary objcctions of thc dcfendant to the plaintiffs complaint are
DENIED.
BY THE COURT,
Charles E. Schmidt, Jr., Esquire
For the Plaintiff
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Douglns B. Marcello, Esquirc
For the Defcndant
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DAVID C. ATKINS,
plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PA
NO. 94-2004 CIVIL TERM
v.
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STATE AUTO INSURANCE COMPANY,
Defendant
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
NOTICE
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You have been sued in Court.
If you wish to defend against
the claims set forth in the following pages, you must take action
within twenty (20) days after this document is served, by entering
a written appearance personally, or by attorney, and filing in
writing with the Court, your defenses or objections to the claims
set forth against you. You are warned that if you fail to do so
the case may proceed without you and a judgment may be entered
against you by the Court, without further notice for any money
claimed or for any other claim or relief requested. You may lose
money or property or other rights important to you.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW:
Court Administrator
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
(717) 240-6200
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NOTICIA
Le han demandado a usted en la corte.
si usted quiere
defenderse de estas demandas expuestas en las paginas siguientes,
usted tiene viente (20) dias de plazo al partir de la fecha de la
demanda y le notificacion. Usted debe presentar una apariencia
escrita 0 en persona 0 por abogado y arachivar en la corte en forma
escrita sus defensas 0 sus objectiones alas demandas en contra de
su persona.
Sea avisado que si usted no se defiende, la corte
tomara medidas y puede entrar una orden contra usted sin previou
aviso 0 notificacion y por cualquier queja 0 alivio que es pedido
en la peticion de demanda.
Usted puede perder dinero 0 sus
propiedades 0 otros derechos importantes para usted.
LLEVE ESTA DEMANDA A UN ABODAGO IMMEDIATAMENTE. SI NO TIENE
ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO,
VAYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE
ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIER
ASISTENCIA LEGAL.
Court Administrator
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
(717) 240-6200
THOMAS, THOMAS AND HAFER
By: \.
Doug
Post ffice
Harrisburg, PA
(717) 255-7238
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DAVID C. ATKINS,
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PA
NO. 94-2004 CIVIL TERM
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
v.
STATE AUTO INSURANCE COMPANY,
Defendant
ANSWER AND NEW MATTER
1. Denied. Answering Defendant is without information or
belief as to the truth of the averments of paragraph 1, hence they
are denied and proof is demanded at time of trial.
2. Admi tted.
3. Denied as stated. It is admitted that Defendant issued an
insurance policy to Plaintiff, David C. Atkins that provides first
party benefits pursuant to the terms and conditions of the policy.
Any and all other averments are denied and proof is demanded at
time of trial.
4. Admitted.
5. Admitted in part and denied in part. It is admitted that
Plaintiff David C. Atkins suffered some injuries in the accident
for which Defendant has paid the outstanding medical bills. It is
denied that Plaintiff suffers continuing injuries or losses as a
result of the automobile accident, including but not limited to
fracture vertebra of the lumbar area, pain the low back, irritation
of the sciatic nerve radiating into the left leg, weakness in both
legs, pain in the hips or soreness in the cervical area.
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6. Admitted in part and denied in part. It is admitted that
plaintiff has incurred some medical expenses for treatment of
injuries sustained in the automobile accident which have been paid
by Defendant. Any allegations that Plaintiff has suffered injuries
requiring additional medical bills other than those already paid by
state Auto are denied and proof is demanded at time of trial.
7. Admitted.
8.
Denied.
It is denied that Plaintiff has continuously
submitted reasonable proof in the amount of loss and reasonable
proofs of the amount of bills incurred.
9.
Denied as stated.
It is denied that Defendant has
"
continuously challenged the medical bills and have made numerous
attempts to establish a reasonable basis for denial. It is instead
averred that Defendant has paid medical bills for the treatment
that is reasonable, necessary and related to the accident. It is
further admitted that Defendant has denied payment of medical bills
for additional treatment that are neither reasonable, necessary,
nor related to the work related accident.
10. Denied. It is denied that Defendant attempted without
good cause to schedule an independent medical examination. To the
contrary, despite claiming ongoing treatment and submitting medical
bills for payment, Plaintiff refused to allow an independent
examination to determine the reasonableness, necessity, and
relationship of said treatment and bills.
11. Admitted.
12. Admitted.
-
13. Denied as stated. The letter, attached to Plaintiff's
complaint, as Exhibit D, speaks for itself, any and all other
averments of paragraph 13 are denied and proof is demanded at time
of trial.
14. Denied as stated. The letter attached to Plaintiff's
Complaint as Exhibit E speaks for itself any and all other
averments of paragraph 14 are denied and proof is demanded at time
of trial. The averments of said exhibit or the legal conclusions
therein are denied and proof is demanded at time of trial.
15. Denied as stated. The letter attached to Plaintiff's
Complaint as Exhibit F speaks for itself any and all other
averments of paragraph 15 are denied and proof is demanded at time
of trial.
16. Admitted.
17 . Admitted in part and denied in part. It is admitted that
Dr. Lehman opined that the treatment provided by Dr. Sanderson was
not medically necessary with regard to Plaintiff's motor vehicle
accident. Dr. Lehman further stated that he do not feel that the
amount of treatment Plaintiff received over such an extended period
of time was medically appropriated and indeed "may well have
contributed to this man's ongoing symptoms."
18. Admitted.
19. Admitted.
20. Admitted.
21. Admitted in part and denied in part. It is admitted the
reconsideration of the orthopedic treatment was performed on
3
February 7, 1994 by Dr. Lehman for forwarding to the Peer Review
organization, which was then forwarded to Defendant. It is further
averred that the Peer Review of the psychological treatment was
completed by Dr. Brick on February 10, 1994 for forwarding on to
the Peer Review organization and then forwarded to state
Automobile. It is further averred that state Auto received the
Peer Review reconsideration results on February 24, 1994 and
forwarded the information of their denial on that same day to
Plaintiff's counsel.
22. Denied. Answering Defendant is without information or
belief as to the truth of the averments that Plaintiff owes
outstanding bills that the Plaintiff believes and avers to be
payable to Dr. Sanderson. Defendant has paid all bills it received
from West Shore Psychological Services.
COUNT I
DAVID ATKINS v. STATE AUTO INSURANCE COMPANY
FIRST PARTY BENEFITS - BREACH OF CONTRACT
23. Paragraphs 1 through 22 are incorporated herein and made
a part hereof as if set forth in full.
24. Denied. It is denied that the bills for West Shore
Psychological Services were submitted to the Peer Review for more
than ninety days after their receipt by Defendant of sufficient
documentation and/or in violation of Pennsylvania Insurance
Regulation Title 31 S69.52(d).
25. Denied. It is denied that an initial determination must
be completed within thirty days after Defendant referred
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27. Denied.
Plaintiff's case to the Peer Review Organization and/or is required
by the Department of Insurance Regulation Title 31 569.52(d).
26. It is denied that Defendant failed to notify Plaintiff of
the initial determination within five days after Defendant received
the initial determination report and/or in violation of the
Department of Insurance regulation Title 31 569.5(e).
It is denied that any additional records were
required to be requested from Dr. Sanderson or West Shore
Psychological Services by Defendant for any initial determination
and/or that Defendant violated the Department of Insurance
Regulation Title 31 569.5(c).
28. Denied. Answering Defendant is without information and
belief as to the truth of averments of paragraph 28, hence they are
denied and proof is demanded at time of trial.
29. Denied. The averments of paragraph 29 state a conclusion
of law to which no responsive pleading is required.
30. Denied. Answering Defendant is without information and
belief as to the truth of averments of paragraph 30, hence they are
denied and proof is demanded at time of trial.
31. Denied. Answering Defendant is without information and
belief as to the truth of averments of paragraphs 31, hence they
are denied and proof is demanded at time of trial.
32. Denied. It is denied that Defendant failed to notify
Plaintiff of the reconsideration determination within five days of
receipt and/or in violation of Title 31, 569.5(1).
5
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33. Admitted in part and denied in part. It is denied that
Defendant has failed or refused to pay any medical bills of
plaintiff which are reasonable, necessary and related to the
automobile accident. It is admitted that Defendant has denied
payment of plaintiff's first party benefits which are neither
reasonable, necessary or related to the automobile accident.
34. Denied. It is denied that Defendant's denial of benefits
is without reasonable foundation or unreasonable.
35. Admitted.
36. Admitted in part and denied in part. It is admitted that
Defendant denied payment of medical bills, including but not
limited to based on a finding that the treatments were not
medically necessary. It is further averred that the treatments
were not reasonable, and further were not related to the automobile
accident. The balance of the averments of paragraph 36 state a
conclusion of law to which no responsive pleading is required.
37. Denied. Answering Defendant is without information or
belief as to the truth of the averments that Plaintiff has secured
the services of Schmidt & Ronca. P.C. as its attorneys, and/or that
attorney fees in the amount of $150.00 an hour are reasonable.
WHEREFORE, Defendant request this Honorable Court to dismiss
Plaintiff's Complaint.
6
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COUNT II
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DAVID C. ATKINS v. STATE AUTO INSURANCE COMPANY
BAD FAITH
3S. Paragraphs 1 through 37 are incorporated herein and made
a part hereof as if set forth in full.
39.
Denied.
It is denied that any additional bad faith
damages are liable and/or may be payable for a claim for first
party benefits or refusal to pay first party benefits, hence it is
denied and proof is demanded at time of trial.
40. Denied. It is denied that Defendant employed the peer
review organization in bad faith or that this particular peer
review organization does a substantial amount of peer review work
for Defendant or has a financial interest in providing a biased
peer review report to Defendant or guaranteed a satisfactory report
to Defendant, hence it is denied and proof is demanded at time of
trial.
41.
Denied.
Any and all allegations of bad faith of
Defendant are denied. The averments of paragraphs 24 through 33 of
Defendant's answer are incorporated herein and made a part hereof.
42.
Denied as stated.
It is admitted that Defendant has
required submission of medical bills incurred by Plaintiff. Any
and all other averments of paragraph 42 are denied and proof is
demanded at time of trial.
43.
Denied.
It is denied that Defendant scheduled an
independent medical examination without good cause. It is denied
7
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that it scheduled an independent medical examination with or
without good cause in and of itself constitutes bad faith.
44. Denied. Any and all bad faith on the part of Defendant
is denied and proof is demanded at time of trial. It is denied
that Plaintiff lost the use of proceeds or was required to hire an
attorney as a result of any bad faith of Defendants, hence it is
denied and proof is demanded at time of trial.
WHEREFORE, Defendant request this Honorable Court to dismiss
Plaintiff's Complaint.
NEW MATTER
45. Plaintiff fails to state a cause of action including but
not limited to first party benefits and/or bad faith.
46. Plaintiff failed to join an indispensable party.
47. Plaintiff fails to allege facts sufficient to state a
claim for punitive damages.
48. Plaintiff's claim for damages pursuant to 42 Pa.C.S.A.
58371 is barred by the specific penalties pursuant to the Motor
Vehicle Financial Responsibility Act, as amended.
49. This Court lacks jurisdiction over the subject matter of
Plaintiff's action.
50. Plaintiff's Complaint. to the extent that it seeks
punitive or exemplary damages violates Defendant's rights to
procedural due process under the Fourteenth Amendment of the United
states Constitution and the applicable state Constitution, and
therefore fails to state a cause of action upon which either
punitive or exemplary damages can be awarded.
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51. Plaintiff I s complaint, to the extent that it seeks
punitive or exemplary damages, violates Defendants right to
protection from "excessive fines" as provided in the Eighth
Amendment of the united states Constitution and the applicable
state constitution, and violates Defendant's right to substantial
due process as provided in the Fifth and Fourteenth Amendments of
the Constitution and the state Constitution, and therefore fails to
state a cause of action supporting the punitive or exemplary
damages claimed.
52. Some or all of Plaintiff I s claims or allegations are
barred by waiver.
THOMAS, THOMAS & HAFER
By:
as . Marcello, Esqu re
30 North Front Street
Post Office Box 999
Harrisburg, PA 17108-0999
(717) 255-7238
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Cynth aD. Butler
CERTIFICATE OF SERVICE
On September 15, 1994, I, cynthia D. Butler, secretary in the
law firm of Thomas, Thomas & Hafer, hereby certify that I sent a
true and correct copy of the foregoing document to the following
counsel of record in the manner indicated below:
Charles E. Schmidt, Jr., Esquire
Schmidt & Ronca, P.C.
209 State Street
Harrisburg, PA 17101
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VBRIJ'ICATION
I, ShUff 1.... M;JJ if" , being an employee of state
Auto Insurance Company, verify that the statements made in the
foregoing document, which are within the personal knowledge of the
undersigned, are true and correct, and as to the facts based on the
information of others, the undersigned, after diligent inquiry,
believe them to be true. And further, this Verification is signed
on the recommendation of my attorneys, who advise me that the
allegations and language in this document are required legally to
raise issues for resolution at trial, by the Court, or by
continuing investigation and preparation for trial. I understand
that some of these allegations may prove inappropriate after
investigation and trial preparation are complete and I leave
determination of these matters to my attorneys on their advice.
I understand that all statements herein are made subject to
the penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn
falsifications to authorities.
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 94-2004 civil Term
DAVID C. ATKINS,
Plaintiff '"
STATE AUTO INSURANCE
COMPANY,
CIVIL ACTION - LAW
Defendant
JURY TRIAL DEMANDED
REPLY TO NEW MATTER
AND NOW, Comes the plaintiff, David C. Atkins, by and
through his attorneys, Schmidt and Ronca, P.C. and sets forth as
follows:
45. Paragraph 45 of the Defendant's New Matter contains a
conclusion of law which does not require a responsive pleading.
46. Paragraph 46 of the Defendant's New Matter contains a
conclusion of law which does not require a responsive pleading.
47. Paragraph 47 of the Defendant's New Matter contains a
conclusion of law which does not require a responsive pleading.
48. Denied. It is specifically denied that 42 Pa. C.S.A.
S 8371 is barred by the Motor Vehicle Financial Responsibility
Law, in that each applies to separate claims for damages.
49. Paragraph 49 of the Defendant's New Matter contains a
conclusion of law which does not require a responsive pleading.
50. Paragraph 50 of the Defendant's New Matter contains a
conclusion of law which does not require a responsive pleading.
51. Paragraph 51 of the Defendant's New Matter contains a
conclusion of law which does not require a responsive pleading.
52. Paragraph 52 of the Defendant's New Matter contains a
conclusion of law which does not
responsive pleading.
l5Iubmitted,
By:
I
Charles E. schm t, Jr.
Attorney for Plaintiff
I.D. 119198
209 state street
Harrisburg, PA 17101
(717) 232-6300
VBRIPICATION
I, Charles E. Schmidt, Jr., Attorney for Plaintiff,
verify that I am attorney of record for the Plaintiff, and that
the foregoing document contains no facts within the knowledge of
the Plaintiff, but rather, is based upon the record or facts
solely within the knowledge of the attorney; and, for that
reason, I make this Verification on Plaintiff's behalf.
I verify that the facts contained in the foregoing document
are true and correct to the best of my knowledge, information and
belief.
I understand that intentional false statements herein are
made subject to the penalties of 18 pa.~~A~IS4904
unsworn falsifications to authorities~ I
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relating to
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RONCA, P.C.
By:
Charles E. Schmid , Jr.
Attorney at Law
209 State Street
Harrisburg, PA 17101
Attorney I.D. '19198
(717) 232-6300
Attorney for the Plaintiff
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CBRTIPICATB OP SBRVICB
AND NOW this I~ l"h day of Sa..pt. 1994, I, Charles
E. Schmdit, Jr., Esquire, hereby certify that I have this
day served the foregoing Reply to New Hatter by depositing a
copy of the same in the United states Mail, Postage Prepaid,
at Harrisburg, Pennsylvania, addressed to:
Douglas B. Marcello, Esquire
THOMAS, THOMAS & HAFER
305 North Front street, 6th Floor
P.O. Box 999
Harrisburg, PA 17108/' 'j
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By:
ONCA, P.C.
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Charles E. Schmidt Jr.
Attorney at Law
209 State Street
Harrisburg, PA 17101
Attorney I.D. '1919S
(717) 232-6300
Attorney for the Plaintiff
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 94-2004 Civil Term
DAVID C. ATKINS,
Plaintiff
Defendant
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
STATE AUTO INSURANCE
COMPANY,
CBRTIPICATB OP SBRV:rCB
L (;>;t
AND NOW this _~rc day of November, 1994, I, Charles E.
Schmidt, Jr., Esquire, hereby certify that I have this day served
a Notice of Deposition of Sherry Miller, by depositing a copy of
the same in the United States Mail, Postage Prepaid, at
Harrisburg, Pennsylvania, addressed to:
Douglas B. Marcello, Esquire
THOMAS, THOMAS & HAFER
305 North Front Street, 6th E
P.O. Box 999
Harrisburg, PA 17108
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By:
Charles E. Schmidt, Jr.
Attorney at Law
209 State Street
HarriSburg, PA 17101
Attorney I.D. #19198
(717) 232-6300
Attorney for the Plaintiff
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DAVID C. ATKINS,
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 94-2004 civil Term
v.
STATE AUTO INSURANCE
COMPANY,
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
Defendant
CBRTZPICATB OP SBRVICB
AND NOW this
3"l
day of November, 1994, I, Charles E.
Schmidt, Jr., Esquire, hereby certify that I have this day served
Plaintiff's Request for production of Documents, by depositing a
copy of the same in the United states Mail, postage prepaid, at
Harrisburg, Pennsylvania, addressed to:
..
Douglas B. Marcello, Esquire
THOMAS, THOMAS & HAFER
305 North Front street, 6th Floo~
P.O. Box 999
Harrisburg, PA 17108
By:
D RONCA, P C.
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Charles E. Schmidt, Jr.
Attorney at Law
209 state Street
HarriSburg, PA 17101
Attorney I.D. '19198
(717) 232-6300
Attorney for the Plaintiff
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 94-2004 civil Term
CIVIL ACTION - LAW
DAVID C. ATKINS,
Plaintiff
STATE AUTO INSURANCE
COMPANY,
Defendant
JURY TRIAL DEMANDED
CBRTIPICATB OP SBRVICB
":'""1 I st-
AND NOW this ~ day of June, 1995, I, Charles E.
Schmidt, Jr., Esquire, hereby certify that I have this day served
a Notice of Deposition of Sherry Miller, by depositing a copy of
the same in the United States Mail, Postage Prepaid, at
Harrisburg, Pennsylvania, addressed to:
Douglas B. Marcello, Esquire
THOMAS, THOMAS & HAFER
305 North Front Street, 6th
P.O. Box 999
Harrisburg, PA 17108
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By:
Charles E. Schmidt, Jr.
Attorney at Law
209 State Street
Harrisburg, PA 17101
Attorney I.D. #19198
(717) 232-6300
Attorney for the Plaintiff
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DAVID C. ATKINS, : IN THE COURT OF COMMON PLEAS
Plaintiff . CUMBERLAND COUNTY, PENNSYLVANIA
.
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v. . NO. 94-2004 civil Term
.
STATE AUTO INSURANCE . CIVIL ACTION - LAW
.
COMPANY, .
.
Defendant . JURY TRIAL DEMANDED
.
PRAECIPE FOR ENTRY OF APPEARANCE
TO THE PROTHONOTARY:
Please enter the appearance of the undersigned as co-
counsel with Charles E. Schmidt, Jr., Esquire, of SCHMIDT AND
RONCA, P.C., on behalf of the Plaintiff in the above-captioned
action.
SCHMIDT AND RONCA, P.C.
By: ~ r ;'J-:vp-
.:I3hn F. Dugg4'n
Attorney at Law
209 State Street
Harrisburg, PA 17101
Attorney I.D. #73074
(717) 232-6300
Attorneys for the Plaintiff
o
CERTIFICATE OF SERVICE
AND NOW this l,tAday of 9~, 1995, I, John F.
Duggan, Esquire, hereby certify that I have this day served a
true and correct copy of the foregoing Praecipe for Entry of
Appearance, by hand-delivering a copy of the same to:
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Douglas B. Marcello, Esquire
THOMAS, THOMAS & HAFER
305 North Front street, 6th Floor
P.O. Box 999
Harrisburg, PA 17108
By:
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Attorney at Law
209 State street
Harrisburg, PA 17101
Attorney I.D. #73074
(717) 232-6300
Attorneys for the Plaintiff
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Plaintiff
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 94-2004 civil Term
v.
.
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STATE AUTO INSURANCE
COMPANY,
CIVIL ACTION - LAW
Defendant
: JURY TRIAL DEMANDED
CERTrFrCATE OF SERvrCE
AND NOW this
;J. tf 'lo-day of I'~""t: 1995, I, Charles
E. Schmidt. Jr., Esquire. hereby certify that I have this
day served the foregoing Plaintiff's Interrogatories
Addressed to the Defendant by depositing a copy of the same
in the United States Mail, Postage Prepaid, at Harrisburg,
Pennsylvania, addressed to:
Douglas B. Marcello, Esquire
THOMAS, THOMAS & HAFER
305 North Front street, 6th Floor
P.O. Box 999
Harrisburg, PA 17108
SCHMIDT AND RONCA, P.C.
By:
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Charles E. ~chmidt, Jr.
Attorney at Law
209 State Street
Harrisburg, PA 17101
Attorney I.D. #19198
(717) 232-6300
Attorney for the Plaintiff
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DAVID C. ATKINS, . IN THE COURT OF COMMON PLEAS
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Plaintiff . CUMBERLAND COUNTY, PENNSYLVANIA
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v. . NO. 94-2004 civil Term
.
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STATE AUTO INSURANCE . CIVIL ACTION - LAW
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COMPANY, .
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Defendant . JURY TRIAL DEMANDED
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CERTIPICATE OP SERVICE
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AND NOW this ~ day of October, 1995, I, Charles E.
Schmidt, Jr., Esquire, hereby certify that I have this day served
a Notice of Deposition of Mark P. Lutness, M.D., by depositing a
copy of the same in the United States Mail, Postage Prepaid, at
HarriSburg, Pennsylvania, addressed to:
Douglas B. Marcello, Esquire
THOMAS, THOMAS & HAFER
305 North Front Street, 6th Fl.
P.O. Box 999
Harrisburg, PA 17108
By:
Mark P. Lutness, M.D.
PHYSICIANS OF REHABILITATION
MEDICINE, P.C.
450 Powers Avenue
Harrisburg ,~A 17109
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Charles E. schmid ,
Attorney at Law
209 State Street
Harrisburg, PA 17101
Attorney I.D. 119198
(717) 232-6300
Attorney for the Plaintiff
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plaintiff
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STATE AUTO INSURANCE
COMPANY,
Defendant
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 94-2004 civil Term
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CBRTzrICATB or SERVICB
AND NOW this
~:)+h day of October, 1995, I, Charles E.
Schmidt, Jr., Esquire, hereby certify that I have this day served
a Notice of Deposition of Douglas K. Sanderson, M.D., by
depositing a copy of the same in the United States Mail, Postage
Prepaid, at Harrisburg, Pennsylvania, addressed to:
Douglas B. Marcello, Esquire
THOMAS, THOMAS & HAFER
305 North Front street, 6th Fl.
P.O. Box 999
Harrisburg, PA 17108
By:
Douglas K. Sanderson, M.D.
205 Grandview Avenue
camp Hill, PA 17011
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Charles E. Schmid , Jr.
Attorney at Law
209 State Street
Harrisburg, PA 17101
Attorney I.D. #19198
(717) 232-6300
Attorney for the Plaintiff
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DAVID C. ATKINS,
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
.
.
v.
: NO. 94-2004 civil Term
STATE AUTO INSURANCE
COMPANY,
.
.
.
.
CIVIL ACTION - LAW
Defendant
JURY TRIAL DEMANDED
.
.
CBRTIPICATB OP SBRV:J:CB
AND NOW this 15/
day of J;;u~~
1995, I, Charles
E. Schmidt, Jr., Esquire, hereby certify that I have this
day served Plaintiff's Objections to Request for Production
of Documents of Defendant, by depositing the same in the
United States Mail, postage Prepaid, at HarriSburg,
,Pennsylvania, addressed to:
./,
Douglas B. Marcello, Esquire
THOMAS, THOMAS & HAFER
305 North Front Street, 6th Floor
P.O. Box 999
Harrisburg, PA 17108
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SCHMIDT AND RONCA, P.C.
By: -1t4 {: F~
f' QIlarles E. S~idt, Jr.
Attorney at Law
209 State Street
Harrisburg, PA 17101
Attorney I.D. /19198
(717) 232-6300
Attorney for the Plaintiff
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DAVID C. ATKINS,
Plaintiff
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
:
v.
: NO. 94-2004 civil Term
STATE AUTO INSURANCE
COMPANY,
: CIVIL ACTION - LAW
.
.
Defendant
: JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
AND NOW this
1ST day of !J(un16/J'l. 1995, I, Charles
E. Schmidt, Jr., Esquire, hereby certify that I have this
day served Plaintiff's Objections to Interrogatories of
Defendant, by depositing the same in the United States Mail,
Postage Prepaid, at HarriSburg, Pennsylvania, addressed to:
",
Douglas B. Marcello, Esquire
THOMAS, THOMAS & HAFER
305 North Front Street, 6th Floor
P.O. Box 999
Harrisburg, PA 17108
SCHMIDT AND RONCA, P.C.
BY~ ~~e::.~~, Jr.
f Attorney at Law
209 State Street
HarriSburg, PA 17101
Attorney I.D. #19198
(717) 232-6300
Attorney for the Plaintiff
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IN THE COURT OF COMMON PLEAS OP
CUMBERLAND COUNTY, PENNSYLVANJ:A
NO. 94-2004 CIVIL TERM
Plaintiff
v.
STATE AUTO INSURANCE COMPANY.
Defendant
CIVIL ACTION - LAW
: JURY TRJ:AL DEMANDED
PRAECIPE TO SETTLE. SATISFIED AND DISCONTINUED
TO THE PROTHONOTARY:
Kindly mark the above-captioned matter settled, satisfied and
discontinued with prejudice.
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By:
Charles E. Schmidt. Jr.. Esquire
209 State Street
Harrisburg, Pennsylvania 17101
Attorney for Plaintiff
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