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of the State of Ohio with its principal office in Columbus, Ohio,
and doing busineBB in PennBylvania with offices at 1000 Nationwide
Drive, Harrisburg, PennBylvania 17011.
J. On or about October J, 1991, Christine Adams waB involved
in a motor vehicle accident.
4. Prior to October J, 1991, Defendant issued a policy of
automobile insurance to Christine Adams, Said policy was in effect
on October 3, 1991, the date of the accident.
5. As a result of the accident, Christine AdamB suffered
various injuries, including but not limited to injuries to the neck
and back and a closed head injury.
6. As a further result of the aforementioned accident,
Christine Adams has been obliged to receive and undergo medical
attention and care and to expend variouB sums of money or to incur
variouB expenses for which medical benefits are payable.
7. Following the accident Christine Adams incurred
reasonable and necessary treatment from, among otherB, Plaintiff,
for accident related injuries. The fair and reasonable charges for
thiB treatment are as set forth on a copy of the bill which iB
attached hereto, made a part hereof and marked aB Exhibit "A".
e. The bills for Plaintiff I s Bervices were submitted to
Defendant for payment.
9. On or about March 25, 1992, Defendant, pursuant to
Section 1797 (b) ( 1) of the Pennsylvania Motor Vehicle Financial
ReBponsibility Law, as amended, has contracted with a peer review
organization, for the purpose of allegedly confirming that Buch
2
treatment, products, serviceB or accommodationB conform to the
profesBional stendards of performance and are medically necesBary.
The name and addreBs of the aforesaid peer review organization is
Vocational Rehabilitation ServiceB, Inc.
10. Roy Lerman, M. D., of Penn Diagnostic Center, Inc.,
performed a retroBpective review of medical utilization. A copy of
the peer review report iB attached hereto as Exhibit "B".
11. By letter dated July 14, 1992, the Defendant refused
payment for certain medical treatment, including the treatment
provided on and after February, 1992, by the Plaintiff, based on
the concluBions provided in said peer review report.
12. It is averred that all medical bills incurred both before
and after the peer review are fair and reaBonable and that said
treatment was medically necessary and related to the accident.
Moreover, pursuant to Section 1797 (a), all bills were to be paid
unless Bubmitted to peer review within 30 days.
13. The Defendant has failed to have a review conducted for
the care, treatment and medical services provided subBequent to the
peer review evaluation yet denied payment for such serviceB.
14. The Peer Review report eSBentially confirmed the
appropriatenesB of the care provided and made no evaluation of the
care or treatment rendered subBequent to the recordB initially
submitted.
15. Defendant has refused to pay the balance due under the
terms and conditionB of the policy of insurance and the Pa.MVFRL.
AB a reBult of the aforesaid, plaintiff was required to hire the
3
services of an attorney to collect the medical bills due.
16. It is averred that the Defendant haB acted in an
unreasonable manner by refuBing payment of Plaintiff's invoices.
Pursuant to Section 1716 of the Pa.MVFRL, Plaintiff iB entitled to
attorney's fees plus intereBt at the rate of twelve percent.
17. Christine Adams assigned to MRS the right to receive
monies otherwise to be paid to the patient under any inburance plan
and to pursue her claims for such monies,
18. It iB further averred that the Defendant haB acted with
no reasonable foundation.
Pursuant to Section 1798 of the
Pa.MVFRL, Defendant iB liable for attorney's fees for such actions.
19. Defendant has undertaken a course of action which has
been designed to unilaterally, and without jUBtification, refuBe
claimB for medical benefits arising out of motor vehicle accidents
and for which the Defendant has contracted to provide inBurance
coverage.
WHEREFORE, Plaintiff demands payment of the full medical bills
due in the amount of $18,478.48, plus reaBonable attorneY'B fees,
costB and interest on said overdue benefits.
COUNT II . BAD FAITH
and INTERFERENCE WITH CONTRACTUAL RELATIONS
20. The foregoing paragraphB are incorporated herein by
reference as though Bet forth in full.
21. All treatment waB provided to Plaintiff after the
effective date of Section 8371 of the Judicial Code, 42 P.S.
Section 8371, effective July 1, 1990,
4
22. It is believed and, therefore, averred that the Defendant
has employed Baid peer review organization in bad faith in that
said peer review organization doeB a substantial amount of peer
review work for Defendant and has a financial interest in provident
to Defendant a biased peer review report.
23. Moreover, said peer review organization has, or may have,
continuously been providing negative peer review reports to this
Defendant and other insurance companies repeating the same language
for the purpoBe of maintaining a steady source of business, thereby
showing a pattern of abuse of the peer review process.
24. It is believed and therefore averred that the Defendant
regularly refers claimB to peer review organizations for review
without a basiB to do BO.
25. In addition, Baid peer review organization gave its
opinion that the injuries were not related to the accident, instead
of determining "medical necessity" or "conformance to standards",
all in violation of Section l797(b)(1).
26. In addition, it is believed that the Defendant had no
reason to believe that Plaintiff's treatment waB not medically
necessary, but instead was intentionally trying to simply "cut of"
medical coverage for which Plaintiff paid a significant premium.
27, It iB believed and, therefore, averred that based on the
allegationB Bet forth above, Defendant is guilty of bad faith.
28. Defendant's unlawful, malicious, unreaBonable and
unjustified conduct has interfered with Plaintiff's contractual
relations with itB patients by making it more expenBive and
5
burdenBome for Plaintiff to perform its contractual obligationB and
haB deprived Plaintiff of the benefit of its contractB, thereby
causing lOBses to Plaintiff.
WHEREFORE, Plaintiff demandB judgment in its favor in an
amount representing appropriate damages pursuant to Section 8371,
including interest, punitive damageB, court COBts and attorney's
feeB.
) \ ~J lqc,
~
R.'~~Littod'
Richard Oare, Esquire
Attorney ID 18631
2020 South Queen Street
York, PennBylvania 17403
(717) 846-3000
1/26/95
Date
\MRS\Adams\statefar.cpl
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171716913700
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'.1 ~I/I'" PATIENT NAME "~.,.", ",
CHRISTINA AllAMS
MEOIC~L nEconDS NO.
...... ..
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PATIENT NUMDER
508533
508~33-6L3"
A 0
(3/02/92 16 10
OATE OF DIRTH
11'16173
,,'" ATTENclNQ cOCTOR
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PLEASE flEFEn 10 P^TIENT NUMBER
ON AlllNOUlnES AND
CQRAESPONOENCE,
,.... ,
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HOf POSTED WHEN nlls DILL W.... 'RE'...RED, OR I' INIUR...HCI!
C...RRIEnS DO NO' ''''Y ANY '...Rr 0' Ttll AMOUHrS IHOWN,
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INSURANCE
PATIENT NAME
REHAB IUISP'TAL IN IIECHAIHCSBURG
P,O BO'
"~CHAN...BURG, PA 170~~
171711>913700
PATIENT NUMDER
I
,50053J
cATE OF DlATH
1
CYCLE 0'1121>''12
MEDICAL RECORDS NO,
'''''AN I'lIt
Clol,'~ h,..
CHR 1 STINA "OAIIS
5005JJ-blJ...
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An ENDING DOCTOR
OJ/02l92 18 10
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11/16'7J 11>95..blJ...
LUPINACCI, 1I1CHAEL
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. CHRIST IN" ADAIIS
RD 3, BOX 811
"SHERMANSDALE PA
17090
N"TlONWlUE IIUTUAL I~S CO
NCN~ UOl 100391
5831C255897
.:II.\~l.
DESCRIPTION OF flOSPITAL SERVice
mrJ_1~~ oil'II~UL
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.3/25 90899 PSYCHOTHERP'I/' '0 ..',803500 192.00 192.00
1...'01 908'01 CONSULT lI...HR 6 ""8ell00 l80.eO 208.00
1'0/08 908'01 CONSULT I/1tHR 6 '0 '0001100 280.00 288.00
1'" 08 90099 PSYCHOTHERP 11 5 't't803500 2'tC.OO 2'tO.OO
''0115 908 'tl CONSULT ll'oIlR 6 '0'0001100 2BO.00 200.00
1...115 90099 PSYCHOTHERP 1/ 5 ""803500 2'00.00 2'tO.OO
l'oll'o 908'01 CONSULT LI'oHR 0 '0..801100 30'0.00 ' 38'0.00
,..12'0 9!t899 PSYCHOTHERP 11 '0 "" 803500 192.00 192.00
,
PSYCHOLOGICAL SERVICES 2112.00 2112.00
13131 ADMIN ADJUSTMENT 00000207 251.C2-
TOT"L OF PAYMENTS t AOJS 251.C2-
lOTAL CLRRENT CHARGES 2112.00 2112.00
OALANCE FORWARD CHARGES 1255.10 IlS5.lC
TO-DATE I'AYIIENTS ADJS. 251.02- 2U.C2-
DEOUCTIBLE AMOUNTS
ACCOUNT BALANCE 3116.08
-
, PATIENT NUMOER
If.lIt1''
I PLEASE nl:FER TO PATIENT t~uMDEn
I ON ALlltlOUIRES ANU
50 0 5 3 J COARESPONOEt'CE,
ADDlTlO"'L ,AHEIIJ BILLING MAY BE Hlen loRY fOR AN'" l:"ARnFSI
NOT POStED WHEN rH11 BILL WAS PREPAnED, on ., ...sunANet
CARnllR! DO HOT PAY ANY PARr 0' TIlE ...MOUtlTIIIHOWH
, , ,'0 YOU~ PHYSICIAN WILL D1LL'YOU,SEPARATELY FOR PROFESSIONAL SERVICES RENDEREc TO YOU ' '
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PAllwr NAME
CclRlSTlNA AOAMS
PA IIEtH NUMOEn Io1EOICM l1F;conns rm
'jU85)] 50853J-blH
,,_,I' DATE OF Olll1li ~)UAI MllJtill_
I'''' "'." ""lJlltll
, , 11l1bl73 lb954blJ't
LU~INACCI, MICItA~L
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CHRISTINA AOAMS
RO J, HUX 817
SHERMANSUALE PA
170'10
_1':''''''' ,,"~,!l."
",,,.,,'1,,,.,,,,,,
NATIONW DE MUTUAL INS CO
NONE 001 lUO]91
'jU37Cl,58'11
DESCRIPTION OF 1l0SPITAL SERVice '
.'!"!".
.4.\"...
U'oIl'l 906'01 CONSULT lI..HR 8 4HOUOO 38".00 ]84.00
05/0b 908'01 CONSULT l1'tHR b 4..601100 l88.00 280.00
0,/20 90841 CUNSULT 114HR b 44801LOO 20B.00 200.00
PSYCHOLOGICAL SERVICES 9bO.00 91>0.00
TUTAL CURRENT CHARGES 9&0.00 960.00
BALANCE FORWARD CHARGES 33b1.10 3367.LO
TO-OAT E PAYMENTS AOJS. 251.02- 251.02-
DEDUCTIBLE AMUUNTS
ACCOUNT BALANCE ..071>.00
, TOTAL ,
--:1MI./l'Y8~
AOOIllOTiILJIrnmTlllllltln UU lIE 'j[c[SnnTrnrn:nV'lnln~n~
'IOr rO'5ffO WHW Htls DILL WAS pnlPAnrD, on If ItHIUJlAtIC[ ] 1 1" 00
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0" ^lLUIOUlRCS AllO
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/lECHAI .;6URG, PA 170!>!>
1717/ DoJ 1-3700
F~D.ID.NO. 23-l01"17!>
PATIENT NAME PATIENT NUMBER
CHRISTINA ADAtlS !>08!>J3
.fAJr.IolINf DAfl
CY CL E
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UHNACCl, MICIIA~L
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CHRI S TINA AOAIIS
RD J,'OOX 817'
SHERMANSOALE PA
17090
NATIONHl E MUTUAL INS CO
NONE DOl lUU3'Jl
~oJ7Cl!>!>697
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06/12 900~1~CONSULT,1/4HR ~~6':~~001100
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hjTALI'CUR~ENT'i:t~RGES" ,:';'
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TO-DATE PAYIIENTS'ADJS" '
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:DEDUCTIBLE:A"OUNTS
: lc'~~J~i~;"'~~L~;~~~~i;.;
"bESCRlPTION OF HOSPITALSERVICE
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!o091 273.39CO
;~X !6091 273.96d~
NAME: Patricia Mansberger
RE: Christine Adams
COMPANY: VRS
FILE: 5837C255897100J910
ADDRESS: 4405 N. Front Street
D.O.I.: 10/03/91
CITY:
Harrisburg
ORIGINAL FORTHCO/Jlfla
UfON PHVSICIAN'S
SIGNATURE
STATE:
PA
DICTATED BUT NOT READ
ZIP CODE: 17110
RETROSPECTIVE REVIEW OF MEDICAL UTILIZATION
This review is being conducted without an examination of the
individual involved.
The review is based on those documents listed and with the
assumption that the diagnosis given by the provide is a correct
one. If more information becomes available at a later time, such
'I will also become documented and reported upon in light of its
content and relationship to this case. The reviewer mayor may
not have had access to the actual diagnostic films or data,
The following is a clinical assessment and opinion, conducted to
the best of my medical ability, and with the information
available. This does not constitute per se a recommendation for
a specific claim or administrative function to be enforced.
Documents reviewed in this claim are:
..
12/19/91
1/18/92 - 2/20/92
Evaluation-Dr. Lupinacci
Progress Notes, Therapeutic Recreation Eval,
Speech pathology/AUdiology Report, F/U-Dr.
Lupinacci
F /U-Dr, Samuels
CtAIHS
02/24/92
VERIFICATION
L:
I verify that the statements made in the foregoing pleading
are true and correct to the best of my knowledge, information and
belief. I understand that false statements herein are made subject
to the penalties of 18 Pa. C, S. 4904 relating to unsworn
falsification to authorities.
Date:
1/' 1./'1 r
/fl~/2 U
Mark Smith
Chief Financial Officer
Healthsouth Rehab Hospital
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
HEALTHSOUTH OF MECHANICSBURG,
INC. ,
Civil Action . Law
Plaintiff,
v.
Docket No. 9$ ~ (119
NATIONWIDE INSURANCE COMPANY,
Defendant.
Jury Trial Demanded
CERTIFICATE OF SERVICE
I, John D. Brigg, Esquire, do hereby certify that on
February 17, 1995, I caused to be served the foregoing Plaintiff's
Interrogatories to Defendant by depositing the same in the United
States mail, postage prepaid, and addressed to the person listed
belo\'f:,
Ms. Adele Hanlon
Claims Representative
Nationwide Insurance Company
1000 Nationwide Drive
Box 2655
Harrisburg, PA 17105
,. ~,
_// " . .../ //-
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---aotin D. B.riggs,~ ESq\}'ke ,/
,~Supreme Court ID U/S2987
~/' 1776 South Queer/Street
f/ York, PA 17403
" (717) 854-4104
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SIIERIFF'S RETURN
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
In the Court of Common Pleas of
Cumberland County, Pennsylvnaia
No. 95-919 Civil Term
Complaint in Civil Action Law
and Notice
Healthsouth of Mechanicsburg, Inc.
VS
Nationwide Insurance Company
R. THOMAS KLINE, Sheriff, who being duly sworn according to law,
says, that he made diligent search and inquiry for the within named
defendant, to wit:
Nationwife Insurance Company
but was unable to locate them
in his bailiwick. He therefore
deputized the sheriff of Dauphin
County, Pennsylvania,
to serve the within
Complaint in Civil Action Law
On
March I, 1995
. this office was in receipt of
the attached return from
Dauphin
County, Pennsylvania.
Sheriff's Costs:
Docketing
Out of County
Surcharge
Dauphin County
Sworn and SUbscribed!? to
So answers:
",~"'. ^
18.00
9.00
2.00
29.25
58.25 pd.
be fore 111e
,/"
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<. ;",
!rf.
THOMAS KLINE, Sheriff
by
atty 3-1-95
this
r~
day of 7~u...<-<A~
19 r,~
, A.D.
c~,.... Q, )\1,j,p,--
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I I
Prothonotary
... ..
COMMONIVI>AI:rll 01' I'HNNA:
COUNTY 01' DAUPIIIN:
SIIEIlII'I"S IlWI'UIIN
NO, 95.919
PAGH 94
AND NOIV: Februllry 27th
IVITIIlN Complaint ,f!, Notice
Nationwide Insurance Compllny
10 95 ,lit 1:22 p, M,
SEHVlm TilE
UPON
-~_..__...__.'--- ..... ---_.- .,- ....-...
IIY PERSONAI,I.Y
IIANDINGTO Theresa Hardy, Legal Secy, and person in charge at time of service
A TRUE ATTESTED COI'Y OF Tim ORIGINAl, Complaint & Notice
AND MAI\1NG I<NOIVN TO
her
TIlE CONTENTS TIIHHEOI' AT their place
of business, 1000 Nationwide Drive, Harrisburg, Pa.
Sworn and subscribed to
b;iom mo ,"i"d'..''(~:::::;
PHOTIIONOTAIlY
SO ANSlVllRS .
1~~' ?f. 4)' ~~
~~ERfF~~tt}~~~;;-PENNA
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ntuTY S/IImlFF
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SIIEllll'l"S COST ScPJ,...l..5 ~
S.IA
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Healthsouth of Mechanicsburg. Inc.
'is.
Nationwide Insurance Compan~
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95-<)1<) Civit."cmTl
----r
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:-iow. February 22. ] 995
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