If you submitted personal injury protection (“PIP”) medical expense claims to Nationwide in Delaware between September 1, 2004 and December 31, 2007, you may be eligible to get a payment from a proposed class action settlement.
A class action settlement has been reached in a class action lawsuit against Nationwide Mutual Fire Insurance Company (“Nationwide” or “Defendant”) pending in the United States District Court for the District of Delaware (styled Geneyne Hart v. Nationwide Mutual Fire Insurance Company, Class Action Case No. 07‐678‐LPS) alleging, among other things, that Nationwide improperly reduced or denied insurance benefits for medical services after submitting medical bills to a computer based bill review audit based upon a reasonableness or usual and customary charge bill review administered by Mitchell Medical, according to the Nationwide Mutual Fire Insurance Personal Injury Protection PIP Medical Expense class action settlement notice.
You are a member of the “Settlement Class” and a “Settlement Class Member” covered by the Nationwide Mutual Fire Insurance Personal Injury Protection PIP Medical Expense settlement if you fall within the following class definition adopted by the Court:
All persons, and their medical providers or other assignees, who (a) submitted first‐party medical expense claims to Nationwide pursuant to Nationwide’s Delaware automobile insurance policy No‐Fault coverage; (b) had their claim submitted by Nationwide to computer pricing review during the period from September 1, 2004 through December 31, 2007; (c) received or were tendered payment but in an amount less than the submitted medical charges based upon the pricing review of the charges; and (d) received or were tendered an amount less than the stated policy limits. Excluded from the Settlement Class is Nationwide, any entities in which Nationwide has a controlling interest, and all of their legal representatives, heirs and successors. Also excluded are any claims resolved and/or discharged or released prior to the date of the Preliminary Approval Order.
Settlement Payments will be made to Settlement Class Members who timely submit valid Claim Forms. The Nationwide Mutual Fire Insurance Personal Injury Protection PIP Medical Expense settlement also protects insureds of Nationwide from certain claims and balance billing from their medical providers. Settlement Class Members who do not exclude themselves from the settlement and who submit a valid Claim Form will be eligible to receive the following Settlement Payments:
• Holders of Claim(s) for Medical Expense Benefits. The legal holder of the right to receive medical expense benefits under a subject No‐Fault coverage will be eligible to receive a payment (“Unpaid Benefits Settlement Payment”) calculated as 125% of the difference between the amount of the charges submitted and the amount previously paid by Nationwide for Covered Claims (defined below).
• Insureds Who Have Previously Paid Difference on Covered Claims. Insureds who, prior to distribution of the Class Notice, paid to their medical providers the difference of the amount of charges and the amount previously paid by Nationwide on Covered Claims will be eligible to receive a payment (“Reimbursement Settlement Payment”) equal to 200% of the amount paid by the insured for the subject Covered Claim charges.
• Exhaustion of No‐Fault Coverage Limits. The “difference” utilized for determining the foregoing Settlement Payments shall be limited to the amount of remaining No‐Fault medical expense coverage benefits under the insured’s No‐Fault coverage as of the date the settlement is finally approved by the Court. Settlement Payments will be distributed pro rata if more than one Settlement Payment is due under No‐Fault coverage that is exhausted by settlement claims.
“Covered Claim” under the Nationwide Mutual Fire Insurance Personal Injury Protection PIP Medical Expense class action settlement reportedly means medical expense charges: (a) submitted under first‐party medical expense coverage to Nationwide pursuant to Nationwide’s Delaware automobile insurance policy No‐Fault coverage (inclusive of such coverage purchased above statutory minimums); (b) that Nationwide submitted to computer pricing review during the period from September 1, 2004 through December 31, 2007; (c) where payment for such medical expense charges was received or tendered but in an amount less than the submitted medical charges based upon the pricing review of the charges; and (d) where the limits of the subject No‐Fault coverage did not exhaust. Potential “Covered Claims” are generally identified on an explanation of benefits by reason code 41 (which used the following or similar explanation: The amount allowed is based on provider charges within the provider’s geographic region), although such potential reductions may not have been applied for a variety of reasons. Expressly excluded from Covered Claims are charges reduced or denied based upon: coverage denials, exhaustion of policy limits, application of a government sanctioned fee schedule, independent medical examination, peer review, and insured co‐pay, deductible or other contribution requirements under the law or policy terms.
Nationwide” reportedly means and includes (for purposes of the settlement) Nationwide Mutual Fire Insurance Company, Nationwide Assurance Company, Nationwide Mutual Insurance Company, Nationwide Property and Casualty Insurance Company, Nationwide Insurance Company of America, Nationwide Affinity Insurance Company of America, and Nationwide General Insurance Company, and each of their respective, present or former officers, directors, employees, agents, contractors, attorneys, insurers, trustees, representatives, predecessors, successors, parent companies, divisions, subsidiaries, affiliates, and assigns, and/or anyone acting or purporting to act for them or on their behalf.
To qualify for a Settlement Payment, you must send in a Claim Form by First‐Class Mail, postage prepaid, and postmarked no later than April 21, 2012 and must be addressed to the Settlement Administrator at: Hart Settlement, c/o Rust Consulting, Inc., P.O. Box 24768, West Palm Beach, FL 33416.
The Court will hold a Fairness Hearing at 11:00 a.m. on February 28, 2012, at 844 N. King Street, Wilmington, Delaware 19801, Courtroom 6B. At this hearing, the Court will consider whether the Nationwide Mutual Fire Insurance Personal Injury Protection PIP Medical Expense settlement is fair, reasonable, and adequate.
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