Alton chiropractor suing insurer for fraud

Steve Gonzalez Oct. 20, 2004, 11:29am

Gerald H. Bemis, an Alton chiropractor, filed a class action complaint against USAA Insurance Company and ADP Integrated Medical Solutions alleging the two companies devised a conspiracy scheme to reduce paid claims.

He has filed two class action cases in Madison County.

Bemis, represented by The Lakin Law Firm of Wood River, alleges that he provided medical treatment to USAA policyholder Linda Steele, who provided a written assignment of medical pay coverage.

Bemis claims the policy had sufficient coverage to pay the medical bills submitted to USAA.

When Steele sustained injuries in a 1992 car accident, Bemis provided her with “reasonable and necessary” medical treatment, anticipating that all medical expenses would be paid up to coverage limits.

Bemis claims he provided Steele with more than $2,000 in medical expenses.

At the time of treatment, Steele agreed to compensate Bemis for all medical treatment rendered, assigned her interest in her medical pay coverage to him in order to pay for the treatment.

During the course of treatment, Bemis claims that he forwarded information regarding her treatment and billing to USAA. He claims that USAA never notified him of a possibility that it would not pay all submitted bills, or that the burden of non-payment would fall on him, even though he provided necessary medical treatment.

After Steele completed his treatment, USAA obtained an ADP treatment report to retroactively review and ostensibly determine the so-called “reasonable and necessary” medical treatment and expenses, according to his complaint.

After receiving the ADP report, USAA allegedly partially refused to pay Bemis’s reasonable and necessary medical treatment and expenses afte he had already provided the treatment.

ADP was dismissed from the case in August 2001. USAA is represented by the St Louis Law firm of Greenfelder, Hemker, and Gale.

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