Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

In Re: Keneisha Thorpe

August 27, 2010

IN RE: KENEISHA THORPE KENEISHA THORPE APPLICANT


Cite as In re Thorpe,

The Ohio Judicial Center 65 South Front Street, Fourth Floor Columbus, OH 43215 614.387.9860 or 1.800.824.8263 www.cco.state.oh.us

Commissioners: Lloyd Pierre-Louis, Presiding Karl C. Kerschner Susan G. Sheridan

ORDER OF A THREE- COMMISIONER PANEL

{1}On November 26, 2007, the applicant filed a compensation application as the result of a collision with a drunk driver which occurred on October 13, 2007. On March 21, 2008, the Attorney General issued a finding of fact and decision determining that the applicant met the necessary jurisdictional requirements to qualify as a victim of criminally injurious conduct and granting her an award of reparations in the amount of $75.00, to Grant Medical Center for services rendered on October 13, 2007.

{2}On December 19, 2008, the applicant filed a supplemental compensation application seeking reimbursement for additional medical expenses incurred. On June 12, 2009, the Attorney General issued a finding of fact and decision concerning the supplemental compensation application. The Attorney General denied the applicant's claim because she sought medical treatment from providers who were not covered under her health insurance carrier and she did not provide a medically necessary reason for seeking treatment from those out-of-network providers. On June 15, 2009, the applicant submitted a request for reconsideration. On September 10, 2009, the Attorney General rendered a Final Decision finding no reason to modify the initial decision. On September 23, 2009, the applicant filed a notice of appeal from the September 10, 2009 Final Decision of the Attorney General. Hence, a hearing was held before this panel of commissioners on July 7, 2010 at 9:30 A.M.

{3}The applicant and her attorney Monique Nicole Madison appeared at the hearing, while Assistant Attorney General Jason Fuller appeared on behalf of the state of Ohio.

{4}The applicant asserted that she went to medical providers recommended by her civil attorney as the result of an accident involving a drunk driver. She did not check with her insurance carrier to verify that the doctors were covered under her health insurance since she believed the offending driver was insured and she would receive compensation from the offender's automobile insurance. However, subsequently she became aware that the offender did not have automobile insurance. At that point, she attempted to submit the bills to her insurance carrier, Cigna, however, some of these expenses were rejected since some providers were out-of-network.

{5}The Attorney General asserts there are two issues that need to be addressed in this appeal. First, whether the expenses incurred are reasonable expenses for reasonably necessary services and, second, whether the applicant failed to utilize a readily available collateral source.

{6}The applicant Keneisha Thorpe described the automobile accident. She stated she chose to see doctors for physical therapy on the advice of her counsel and did not check to see if those doctors were in her insurance carrier's network. Ms. Thorpe became aware that the offending driver did not have automobile insurance when his alleged car insurance carrier rejected payment of her medical expenses.

{7}The applicant was then shown Applicant's Exhibit 1, a copy of a Traffic Crash Report dated October 13, 2007. The applicant testified that this document noted that the offending driver had automobile insurance. The applicant was then shown Applicant's Exhibit 2, a November 13, 2007 letter from the office of Attorney Byron Potts. The applicant testified this document revealed that the offending driver did not have automobile insurance at the time of the collision.

{8}Upon cross-examination, the applicant admitted she saw two physical therapists: Columbus Injury and Rehab. and Franklin Park Physical Medicine. She switched medical providers due to scheduling difficulties. She acknowledged within a week or two after the accident she became aware that the offending driver did not have insurance. However, she stated she continued to have approximately 46 therapy sessions.

{9}Upon questioning by the commissioners, the applicant stated she never inquired whether her providers were in or out of network with Cigna, her health insurance carrier. The applicant stated during her course of treatment medical providers never informed her that they were in or out-of-network providers nor did she receive bills from the providers until the treatment was concluded. Ms. Thorpe related her previous experiences with medical providers required her to present her insurance card and pay a $15.00 co-pay. She was under the belief that physical therapy was covered under her Cigna insurance policy and that an in-network provider would require the payment of a co-pay. Whereupon the testimony of the applicant was concluded.

{10}The Attorney General called Mary Barnett, Crime Victims Compensation economic loss investigator to testify. Ms. Barnett related that she investigated this claim, and during the course of that investigation contacted all of the applicant's medical providers. Grant Medical Center was the only provider aware of Ms. Thorpe's health insurance coverage.

{11}Ms. Barnett was shown State's Exhibit A, a letter from Attorney Byron Potts' office dated February 18, 2009. This letter indicated that the physical therapy providers were recommended by their office. Furthermore, when Ms. Barnett contacted Cigna, she was informed they would cover 20 physical therapy visits per year with no dollar maximum, if an in-network provider was selected. Finally, Cigna ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.