Keystone Care v. Grossinger, B.

Superior Court of Pennsylvania·Decided November 21, 2016·No. 1051 EDA 2015·Unpublished

Opinion

J-A08013-16

NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37

KEYSTONE CARE ADMINISTRATIVE IN THE SUPERIOR COURT OF SERVICES, INC., PENNSYLVANIA

Appellee

v.

BRUCE GROSSINGER, D.O.,

Appellant No. 1051 EDA 2015

Appeal from the Judgment Entered March 9, 2015 In the Court of Common Pleas of Montgomery County Civil Division at No(s): 06-04049

BEFORE: BOWES, OLSON AND STRASSBURGER,* JJ.

MEMORANDUM BY BOWES, J.: FILED NOVEMBER 21, 2016

Bruce Grossinger, D.O. (“Physician”) appeals from the March 12, 2015

judgment entered in favor of Keystone Care Administrative Services, Inc.

(“KCAS”) following a non-jury trial.1 After thorough review, we affirm.

KCAS, a third-party claims administrator for insurance companies,

entered into two retainer agreements with Physician in which it agreed to

prepay him in anticipation of professional services he would provide for

____________________________________________

1 Physician purported to appeal from the March 9, 2015 order denying him post-trial relief and granting KCAS’s petition for attorneys’ fees and interest. The appeal is proper from the judgment, which was entered on the docket on March 12, 2015, not the denial of post-trial relief. We have amended the caption accordingly.

* Retired Senior Judge assigned to the Superior Court. J-A08013-16

certain personal injury cases. The prepayment arrangement was designed

to assist KCAS in procuring medical expert services on behalf of a financially

ailing Legion Insurance (“Legion”), in anticipation of its release from

rehabilitation.2

Physician’s counsel drafted the first agreement on or about November

1, 2002. It recited that KCAS had received permission and funds from

Legion, then in rehabilitation, “to engage duly qualified physicians to provide

medical services for certain individuals identified by KCAS” and “to

compensate Physician prior to the delivery of such Services.” Agreement,

11/1/02, at 1. Paragraph 7 of the Agreement, entitled Compensation,

provided that, “KCAS had provided Physician with the Funds as payment in

advance for the provision of the Services” with the “Amounts to be earned

by the Physician upon completion of the Services for each individual

identified.” Id. at 4 (emphasis original). The term of the agreement was

one year or until the Physician’s completion of services with respect to all

cases listed, whichever occurred first.

2 Rehabilitation and liquidation involve the take-over of an insurance company’s assets and operations by the State Insurance Commissioner when the company’s annual report reveals it is in substantial financial difficulty. Where the Commissioner believes that it is possible to save the company, it generally orders rehabilitation. When the company is deemed unsalvageable, liquidation is ordered.

-2- J-A08013-16

The second agreement was drafted on February 26, 2003, bearing an

effective date of March 1, 2002, but executed one year later. Under its

terms, Physician was retained to provide depositions and trial testimony if

needed in certain designated cases. Again, the funds were characterized as

“payment in advance” for the provision of deposition and expert witness

testimony. Agreement, 3/1/03, at ¶7 (emphasis original). While the

agreements are quite similar, the second agreement additionally provided

that “KCAS may request that Physician return certain of the Funds, as the

services contemplated hereunder may not be required for a given case.” Id.

at ¶2c. It further provided that “Physician shall be obligated to return those

amounts requested by KCAS, within a reasonable time period, so long as

Physician shall not have furnished Services in connection with such case

prior to the request.” Id. The agreement would “automatically terminate

upon the earlier of (i) the provision of Services by Physician with respect to

all cases” or (ii) a period of two (2) years.” Id. at ¶6a.

Legion went from rehabilitation to liquidation and Physician provided

no services under either agreement. By letter dated April 8, 2004, KCAS

asked Physician to remit the prepayments but Physician did not comply with

the demand. KCAS commenced this contract action in March 2006 to

recover the $77,500 it prepaid Physician under the two agreements,

together with attorney’s fees and interest due to Physician’s breach.

-3- J-A08013-16

Physician filed an answer and new matter to the complaint on March

31, 2006, in which he admitted that he signed the agreements and received

prepayments totaling $77,500. He alleged, however, that he performed

services ancillary to those identified in the agreements, the value of which

exceeded the amount in controversy. Furthermore, Physician pled that he

suffered a loss of income because he declined other business in order to set

aside dedicated hours for the performance of services under the agreements

that failed to materialize. Answer and New Matter, 3/31/06, at ¶7. He

asserted a counterclaim for $3,500, which he subsequently reduced to

$2,500.

During the course of discovery, KCAS filed several successful motions

to compel Physician to provide answers to interrogatories and responses to

requests for production of documents. In opposition to KCAS’s motion to

compel Physician’s deposition, Physician maintained that his deposition

should be delayed to permit him to investigate his theory that the

agreements herein were calculated to defraud first the insurance carrier, and

then the state liquidator, and that they were void or voidable as against

public policy. By order entered April 19, 2011, the court granted KCAS’s

motion to compel the deposition of Physician.

On November 23, 2011, Physician filed an “Amended Motion to Amend

Defendant’s New Matter,” representing therein that he had only become

aware of the fact that KCAS executed similar prepaid services agreements

-4- J-A08013-16

with lawyers and other doctors, the purpose of which was to exhaust

deductibles KCAS had with Legion and Villanova Insurance Companies. He

asserted that KCAS was a defendant in lawsuits filed by Legion and the

Pennsylvania State Guaranty Fund to recoup the monies paid out under

these agreements, raising the question whether KCAS was the real party in

interest in this case. Furthermore, Physician asserted that KCAS used the

prepayments as deductible offsets, and argued that it was fraudulent for

that entity to sue for the return of the prepayments. Physician sought leave

to amend his new matter to plead KCAS’s lack of standing and to assert that

it was not the real party in interest.

In opposition to the proposed amendment, KCAS denied that it was

artificially exhausting deductibles or receiving any offset. Moreover, it

averred that Legion was in liquidation and that the insurance commissioner

was not suing to recoup these monies. Additionally, KCAS contended that

Physician leveled this same charge in correspondence dated March 23, 2006,

prior to filing its original answer and new matter, which was proof that

Physician had long known of this issue but failed to timely plead it. KCAS

contended that since Physician did not file preliminary objections or plead it

in his answer, the issue was waived. Furthermore, KCAS asserted that it

would suffer prejudice if Physician was permitted to amend and raise the

Free access — add to your briefcase to read the full text and ask questions with AI

Keystone Care v. Grossinger, B., (Pa. Ct. App. 2016).

Keystone Care v. Grossinger, B. (Keystone Care v. Grossinger, B.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Guy v. Liederbach
459 A.2d 744 (Supreme Court of Pennsylvania, 1983)
Collins v. Allstate Indemnity Co.
626 A.2d 1162 (Superior Court of Pennsylvania, 1993)
Frickert v. Deiter Bros. Fuel Co., Inc.
347 A.2d 701 (Supreme Court of Pennsylvania, 1975)
Barium Steel Corp. v. Wiley
108 A.2d 336 (Supreme Court of Pennsylvania, 1954)
County of Delaware v. J.P. Mascaro & Sons, Inc.
830 A.2d 587 (Superior Court of Pennsylvania, 2003)
SPIRES Et Ux. v. Hanover Fire Ins. Co.
70 A.2d 828 (Supreme Court of Pennsylvania, 1950)
Fumo v. City of Philadelphia
972 A.2d 487 (Supreme Court of Pennsylvania, 2009)
Jalapenos, LLC v. GRC General Contractor, Inc.
939 A.2d 925 (Superior Court of Pennsylvania, 2007)
City of Philadelphia v. Spencer
591 A.2d 5 (Commonwealth Court of Pennsylvania, 1991)
Mastroni-Mucker v. Allstate Insurance
976 A.2d 510 (Superior Court of Pennsylvania, 2009)
Trizechahn Gateway LLC v. Titus
976 A.2d 474 (Supreme Court of Pennsylvania, 2009)
John B. Conomos, Inc. v. Sun Co., Inc.
831 A.2d 696 (Superior Court of Pennsylvania, 2003)
In Re Estate of Alexander
758 A.2d 182 (Superior Court of Pennsylvania, 2000)
In Re Milton Hershey School
911 A.2d 1258 (Supreme Court of Pennsylvania, 2006)
Hull v. Tolentino
536 A.2d 797 (Supreme Court of Pennsylvania, 1988)
Mineo v. Tancini
536 A.2d 1323 (Supreme Court of Pennsylvania, 1988)
Kripp v. Kripp
849 A.2d 1159 (Supreme Court of Pennsylvania, 2004)
Somers v. Somers
613 A.2d 1211 (Superior Court of Pennsylvania, 1992)
Jarl Investments, L.P. v. Fleck
937 A.2d 1113 (Superior Court of Pennsylvania, 2007)
City of Philadelphia v. Commonwealth
838 A.2d 566 (Supreme Court of Pennsylvania, 2003)