Keystone Care v. Grossinger, B.

Superior Court of Pennsylvania·Decided November 21, 2016·No. 1051 EDA 2015·Unpublished

Opinion

NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37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

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.

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.

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

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 defenses five years into litigation as it would have to re-engage in discovery

on these new issues and the associated delay would reduce the likelihood of a disposition by the statutory liquidator.

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

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