Insurer takes advantage of federal decision in defending Lakin class action
Defendants usually deny everything a plaintiff alleges, but in a Lakin Law Firm class action Employers Mutual Casualty gladly admits that chiropractor Frank Bemis never contracted with it.
The allegation took on new meaning July 24, when U.S. District Judge Phil Gilbert of Benton dismissed a chiropractor's similar class action against Travelers Insurance.
Gilbert ruled that under Illinois law, no one can construe two separate contracts as one.
His decision cast a cloud over many chiropractor suits in Madison and St. Clair counties.
Employers Casualty sought to take advantage of his decision in an Aug. 13 answer to an amended complaint the Lakins filed July 15 in a Madison County case.
The Lakins, who accuse Employers Mutual of cheating Bemis and his clinic out of $14 through a preferred provider organization, allege that he "never contracted directly with Employers to enter into a purported PPO."
By the time Employers Mutual answered, the allegation sounded like sweet music.
"EMC admits that plaintiffs never contracted directly with EMC," wrote Thomas Pender of Chicago.
"The claims of the plaintiffs are barred by the lack of any contract and/or similar commercial relationship between them and defendant," he wrote.
Bemis alleges that he billed $62 for treating an accident victim and that Employers Mutual reduced the payment to $48.
His complaint states that, "In order to reduce its claim expenses, Employers uses improper managed care tactics which reduce reimbursement to health care providers."
The Lakins allege that, "Employers does not dispute the reasonableness or necessity of the medical charges, nor that the treatment is for injuries relating to covered losses."
They allege, "Employers has illegally reaped huge savings while giving no consideration to health care providers."
They allege that Employers has improperly discounted thousands of medical bills.
"Many health care providers may not even be aware of Employers' sophisticated scheme," they allege.
They claim Employers violated the Illinois consumer fraud act.
In case Illinois law doesn't apply, they allege violations of Washington consumer law.
Their bid to invoke law from 2,000 miles away carries a disclaimer that Washington law "does not expressly prohibit recovery in this type of case."
Under Washington law, they assert a claim for punitive damages.
For Employers Mutual, Pender answered that Bemis's failure to protest the payment before filing suit precludes him from obtaining relief.
Pender argues that because Bemis treated the patient on a workers' compensation claim, Bemis should have exhausted administrative remedies before suing.
Circuit Judge Daniel Stack presides over the case.
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