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BAKSALARY v. SMITH

April 19, 1989

RICHARD BAKSALARY, et al.
v.
PAUL J. SMITH, et al.; In re Lawrence Steinberg



The opinion of the court was delivered by: POLLAK

POLLAK, UNITED STATES DISTRICT JUDGE

 Plaintiff, Lawrence Steinberg, contends that defendant Home Insurance Company's failure to reimburse him for all medical expenses incurred following his work-related injury violates the Consent Decree entered by the parties and approved by a three-judge panel in Baksalary v. Smith, 591 F. Supp. 1279 (E.D. Pa. 1984).

 For the purposes of this motion, the parties have submitted the following stipulated facts:

 1. Lawrence Steinberg (Steinberg) was injured on October 1, 1980 while in the course of his employment. Steinberg has testified, uncontradicted, that he fell, striking his head and back on his employer's machinery and/or floor. He also testified, uncontradicted, that the trauma rendered him unconscious.

 2. Home Insurance Company (Home) as the employer's workman's compensation insurer, paid total disability benefits from October 2, 1980 which payments are continuing. A Notice of Compensation Payable (NCP) was filed whereby Home recognized a "lower back strain with bruised coccyx." Under Pennsylvania law the NCP must be filed within 21 days of the accident and is not conclusive on the employee who is not involved in its preparation.

 3. Home was a class defendant in the captioned litigation.

 4. In May, 1981, Steinberg came under the care of Parviz Kambin, M.D. a Board certified orthopedic surgeon. In March, 1982, Kambin had Steinberg admitted to the Graduate Hospital and diagnosed Steinberg as having a herniated lumbar disc and, in his opinion, an accident related psychological overlay and depression. Home had Steinberg evaluated on November 23, 1982 by John T. Williams, M.D., a Board certified orthopedic surgeon who was of the opinion that Steinberg had effected a full and final recovery from any and all orthopedic injuries.

 5. Before operating in March 1982, Dr. Kambin was concerned about Steinberg's psychological state and had Arnold Sadwin, M.D. a Board certified psychiatrist, examine Steinberg in Graduate Hospital. Dr. Sadwin did not believe that Steinberg was able to tolerate an operation due to the psychological trauma. It is Dr. Sadwin's opinion that Steinberg's psychological problems are related to the October 1, 1980 accident. Dr. Sadwin is also of the opinion that Steinberg had a pre-existing borderline personality disorder which was and still is aggravated by the October 1, 1980 accident.

 6. Both Dr. Kambin and Dr. Sadwin continued to treat Steinberg and are still doing so to date. Dr. Sadwin has ordered psychological tests through Dr. J. Gordon at the University of Pennsylvania and Dr. I. Gerson. All doctors have written reports diagnosing objective findings of physical and psychological problems. Dr. Sadwin also ordered psychological therapy through Dr. J. Porter, a Professor at West Chester University, whose opinion is consistent with that of Dr. Sadwin.

 7. Home was aware of the March 1982 hospitalization at Graduate, and the psychiatric problems discovered therein, within a reasonable time thereof and paid for said bill.

 8. Home received directly and/or indirectly (through counsel) reports from Dr. Sadwin, Dr. Porter and Dr. Kambin throughout 1982, 1983, 1984 and 1985 and was aware of their opinions.

 9. Home paid Dr. Kambin's bill for 1982/83 services (over $ 1,700) on January 6, 1984. However, his subsequent treatment bills have been timely paid to date. Home recognizes its liability to pay for Dr. Kambin's orthopedic tests, appliances and prescriptions and believes that it has paid same. However, Steinberg contends that he has not been reimbursed for any of Dr. Kambin's prescriptions (submitted to Home) and that he has no knowledge of the payment of the bills for tests and appliances whose providers have been dunning him.

 10. Dr. Sadwin's bills were paid through November 1983 but have not been paid since. Home has refused to pay Dr. Sadwin's prescriptions from 1982 to date. Dr. Sadwin's unpaid bills total about $ 2,800.

 11. Dr. Porter's bill, totalling about $ 2,600 for treatment from 1982 to July 1984 was not paid until about August 1984. Subsequent bills have ...


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