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 Wilke

Court of Claims of Ohio

September 25, 2019

IN RE: BRITTANY WILKE BRITTANY WILKE Applicant

          Sent to S.C. Reporter 12/10/19

          DECISION OF THE MAGISTRATE

          DANIEL R. BORCHERT MAGISTRATE Judge

         {¶1} On October 25, 2018, applicant, Brittany Wilke, filed a compensation application as the result of assault which occurred on September 8, 2018. On February 22, 2019, the Attorney General issued a finding of fact and decision determining that applicant met the jurisdictional requirements to qualify as a victim of criminally injurious conduct pursuant to R.C. 2743.51(C)(1). Applicant was granted an award of reparations in the amount of $923.29, of which $625.94 represented reimbursement of dental expenses incurred at West Chester Dental Group and $297.35 represented reimbursement of work loss incurred from September 8, through September 16, 2018. However, the Attorney General noted that applicant's insurance carrier was CareSource. Applicant voluntarily went to a dental provider that did not take CareSource for the services performed, accordingly, the Attorney General denied reimbursement of these expenses pursuant to R.C. 2743.60(D).

         {¶2} On March 5, 2019, applicant submitted a request for reconsideration. Applicant explained the reason that treatment was not sought with Hassan Dawas, D.D.S., a CareSource provider. Applicant contends due to the "bad smell", "stained chairs & dirty floors & walls" and "rude dentist", she left the office and sought treatment at West Chester Dental Group, a non CareSource dentist. Applicant seeks reimbursement of all expenses incurred at West Chester Dental Group.

         {¶3} On March 20, 2019, the Attorney General rendered a Final Decision finding no reason to modify the initial decision. On April 15, 2019, applicant filed a notice of appeal from the March 20, 2019 Final Decision of the Attorney General. Hence, a hearing was held before this magistrate on July 11, 2019 at 9:45 a.m.

         {¶4} Applicant Brittany Wilke and her attorney, Robert Porter, III appeared via telephone, while the state of Ohio was represented by Assistant Attorney General Lauren Angell.

         {¶5} Applicant stated the basis of the appeal is the reimbursement of dental expenses incurred as a result of the criminally injurious conduct. Applicant asserted she did not voluntarily go outside her network with CareSource to seek dental care and treatment. The Attorney General conceded that applicant was a victim of criminally injurious conduct on September 8, 2018. Applicant was transported to Mercy Health Fairfield Hospital and then to University of Cincinnati Health Hospital ("U of C") for treatment as the result of the injuries sustained at the time of the assault. All these expenses were paid by Medicaid aka CareSource. Later, she sought follow up care with a Medicaid/CareSource dentist Dr. Hassan Dawas, D.D.S. However, she received no treatment from this dentist and went to an out-of-network dentist, West Chester Dental Group.

         {¶6} Currently, the Crime Victims Compensation Fund has paid for applicant's work loss plus all dental expenses which Medicaid/CareSource would have paid for if she had chosen to seek treatment from a network dentist. If she would have chosen an in-network dentist, Medicaid/CareSource would not have paid $525.00, for a flipper and $100.94 for a dental consultation. These expenses were paid by the fund. However, the remainder of the expenses were not paid pursuant to R.C. 2743.60(H), since she unreasonably failed to utilize a readily available collateral source. Finally, the Attorney General noted the claimed expenses were just under $13, 000, however, $5, 007.00 of these expenses were paid by applicant's father, who is not a party to this action so these expenses cannot be claimed for reimbursement.

         {¶7} Applicant, Brittany Wilkes was called to testify. Initially, applicant described the incident leading up to her injuries. After she was assaulted she went to the emergency room at Mercy Health Fairfield Hospital and was later transferred to U of C Hospital. Upon leaving the hospital she was informed to see a dentist for further treatment concerning the dental injuries she sustained at the time of the assault.

         {¶8} Applicant stated she initially saw Dr. Hassan Dawas, D.D.S., an in-network provider. CareSource provided her the name of this dentist. Applicant related upon arrival at the dental office, the personnel were very unfriendly. The dentist wanted to pull her teeth rather than trying to save them.

         {¶9} She stated the dental office smelled bad and the dentist was dressed inappropriately. He proposed to extract the affected teeth, which applicant deemed to be unacceptable. Consequently, she chose not to seek treatment from this dentist.

         {¶10} Applicant stated she attempted to contact other in-network dentists and either she could not get in until months later or they were not taking new patients. Therefore, she chose to go to West Chester Dental Group, a practice outside of the CareSource network. She stated her teeth were successfully saved after months of treatment. She incurred a total of $10, 579.00, for treatment received with the West Chester Dental Group. She related she submitted these expenses to CareSource on multiple occasions, however, these expenses were denied since West Chester Dental Group was an out-of-network provider. Ms. Wilke related CareSource gave her inconsistent responses due to her requests for reimbursement, however, on April 17, 2019, she received a letter denying reimbursement for expenses incurred at West Chester Dental Group.

         {¶11} Upon cross-examination, applicant stated she had worked at her job with Hire Solution for approximately three weeks to a month, prior to being injured. She related she earned $15.00 per hour.

         {¶12} Ms. Wilke was asked whether she called Millvale Health Center to determine if they had CareSource approved dentists. Furthermore, U of C Hospital provided twelve CareSource dental providers. She was asked whether she called all of these dentists. She was specifically asked about Milldale Health Center, to which she replied she could not remember. The Attorney General referenced the form provided by U of C Hospital, which listed Medicaid/CareSource dental providers in Hamilton, Clermont, Butler, Adams, Brown counties in Ohio, and three counties in Kentucky. Applicant stated she could not recall contacting any of these dental providers. Next, the Attorney General questioned applicant about dental providers, again provided by U of C Hospital, which used a sliding fee scale. Applicant again related to the best of her knowledge she did not call dentists who used a sliding fee scale.

         {¶13} Upon redirect-examination, Ms. Wilke was asked if she received a list of dentists from U of C Hospital. She stated she did not believe so. She asserted she called CareSource, and none of the dentists they provided were able to see her on a timely basis. Whereupon, Brittany Wilke's testimony was concluded.

         {¶14} Next, applicant called Kim Kirby, applicant's mother to testify. Ms. Kirby related she learned about her daughter's assault the next morning while Ms. Wilke was still at U of C Hospital. Ms. Kirby testified she was present when the oral surgeon stated that one tooth had been knocked out, another tooth possibly needs to be pulled. Upon release from U of C Hospital, Ms. Kirby ...


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.