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DE MOSS v. METROPOLITAN LIFE INS. CO.
June 18, 1984
LOUIS De MOSS, t/a PARK COUNSELING SERVICE, Plaintiff,
METROPOLITAN LIFE INSURANCE COMPANY, Defendant; LOUIS De MOSS, t/a PARK COUNSELING SERVICE, Plaintiff, v. VOLKSWAGEN OF AMERICA, INC., Defendant
The opinion of the court was delivered by: ZIEGLER
In separate complaints, plaintiff has filed suit against Metropolitan Life Insurance Company for libel and tortious interference with prospective contractual relations, and Volkswagen of America for tortious interference with prospective contractual relations. Jurisdiction is based on diversity of citizenship.
The claims arise from letters sent by Metropolitan to employees of Volkswagen. The letters advised the employees that their employee benefit plan did not cover psychological services rendered by plaintiff and others. The complaints allege that the letters were defamatory and caused many clients to terminate psychological counseling with plaintiff. Defendants argue that Pennsylvania law places upon them a duty to inform the employees as to why certain medical services are not covered by the benefit plan. We agree with defendants that insurers are immune from liability under Pennsylvania law when exercising their statutory duty to inform clients of changes in insurance coverage. We therefore will grant defendants' motion for summary judgment.
Plaintiff is a psychologist, licensed by the Commonwealth of Pennsylvania. He practices under the name of Park Counseling Service in Greensburg, Pennsylvania. For several years before 1982, plaintiff treated a number of Volkswagen employees in the regular course of his business. Metropolitan routinely processed and paid Volkswagen employee claims for health services rendered by psychologists, including plaintiff. In late 1981, a Volkswagen corporate benefits administrator discovered that its insurance carrier, Metropolitan, was paying for psychological counseling and treatment. She contacted Blue Cross/Blue Shield of Michigan, which developed the administrative manual describing the scope and level of Volkswagen health insurance benefits. Blue Cross then informed her that the Volkswagen plan did not cover services rendered by a psychologist unless they were rendered under the direction of a psychiatrist or by a psychologist employed by an approved facility. Blue Cross did not determine Park Counseling to be an approved facility for the purposes of the plan.
According to Volkswagen, Metropolitan was notified in January, 1982 that the insurance company should only pay claims for psychological services rendered under the direction of a psychiatrist or rendered through an approved facility. Volkswagen states that neither Louis DeMoss nor Park Counseling was ever singled out by Volkswagen in its discussions with Metropolitan.
This will acknowledge receipt of your statement of claim indicating services rendered by Park Counseling Service on January 9, 1982 for which a charge of $ 60.00 was incurred.
According to your group plan with Volkswagen, psychologists are not recognized as payable providers and Park Counseling does not appear to be an approved facility. Please be advised we have paid $ 60.00 in benefits for this charge but in the future charges from pychologists (sic) or Park Counseling Services will not be considered.
We trust this will satisfactorily explain our actions in this matter. If we can be of any further assistance please feel free to contact us at 814-266-0511.
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