Forth v. Allstate Indemnity Co‪.‬

Date Submitted: November 12, 2004 OPINION After Pat Forth's daughter was injured in an automobile accident, Forth filed claims for the resulting medical expenses with her then personal-injury-protection (PIP) insurer, Allstate Indemnity Company. Allstate paid only a portion of the claimed expenses, and Forth sued Allstate for herself and as representative of a putative class of PIP claimants. Forth asserts Allstate is arbitrary in its PIP claim practices in paying only those portions of claimed medical expenses which do not exceed those which rank at the eighty-fifth percentile of medical expenses for the same treatment or procedure in a third-party contractor's computerized database. Forth asserts Allstate should, instead, pay ""reasonable"" medical expenses as determined by an independent, fair evaluation. Forth amended her pleadings to remove any request for damages, leaving requests for only declaratory judgment and injunction.1 Forth's remaining requests include both retrospective and prospective relief. She seeks retrospective relief requiring Allstate to review her past claims, and those of the putative class, using an independent and fair evaluation---not its computerized Medical Bill Review System (MBRS) and the eighty-fifth percentile standard currently used with MBRS---and to pay her, and her putative class members, what that new review shows Allstate owes them, if anything. Prospectively, Forth seeks to enjoin Allstate from using MBRS and the eighty-fifth percentile standard on future claims.