Fill and Sign the Complaint for Intentional Interference with Attorney Client Relationship Form

- 1 - IN THE CIRCUIT COURT OF _________________ COUNTY, _________________ ____________________VS._________ , _______________, AND _____________________ COMPLAINT Comes now the plaintiff, _________________, by and through his attorney, ___________, and files this his cause of action against the defendants, _________________, _________________, and _________________, and in support of same would state as follows, to-wit: 1. The plaintiff, _________________, is an adult resident citizen of (Insert county), (Insert state). The defendant, _________________, is an adult resident citizen of (Insert county, (Insert state) and may be served with personal service of process at _________________, (Insert city), (Insert state and zip code). The defendant, _________________, is a corporation organized and existing under the laws of the State of _____________ and is authorized to do business in the State of __________________ and was doing business in the State of ______________ at all pertinent times complained of herein. The defendant, _________________, has as its registered agent for process _________________, _________________, (Insert city, state and zip code). The defendant ________________, is a corporation organized and existing under the laws of the State of _________________. This defendant has designated as its registered agent for service of process in the State of (Insert state) _________________, _________________, (Insert city, state and zip code). 2. At all times and dates herein mentioned, _________________, was an employee of _________________ and was a duly authorized agent of the defendant, _________________.The plaintiff, _________________, was employed by _________________ as a truck driver and on (Insert date), 20__, was involved in a vehicular accident while working for _________________. Thereafter, the workers' compensation carrier for _________________, the defendant _________________, began paying compensation benefits for temporary total disability and medical expenses incurred by the plaintiff as a result of the work related injury. - 2 -3. On or about (Insert date), 20___, the defendant, _________________, an employee, agent, and servant of _________________ called the attorney for plaintiff, _________________, and requested that _________________ be allowed to work with _________________ through his rehabilitation process. _________________ had been hired by the defendant, _________________, to oversee _________________'s rehabilitation process and obtain medical records concerning the treatment and care provided by health providers to plaintiff, _________________. On (Insert date), 20___, the defendant, _________________, wrote Attorney ____________ confirming _________________’s consent that _________________ and _________________ could work with _________________ through his rehabilitation process. A copy of said correspondence is attached hereto and marked as Exhibit "A" and asked to be incorporated herein as if fully set out in words and figures. 4. On or about (Insert date), 20___, Attorney _________________ wrote defendant, _________________, at _________________ rescinding her right to attend any medical examinations or treatment with Mr. _________________ and the approval of _________________ to work with Mr. _________________ through his rehabilitation was further rescinded. A copy of said correspondence is attached hereto and marked as Exhibit "B" and asked to be incorporated herein as if fully set out in words and figures. Thereafter, the defendant, _________________, continued to have ex parte communications with the plaintiff's treating physicians and further, she continued to have ex parte communications directly with the plaintiff, _________________, after being advised to cease all contact with _________________ and his treating physicians. On or about (Insert date ), 20___ Attorney ___________ wrote _________________, a claims representative with the defendant, _________________ advising her that _________________'s involvement with _________________ was to cease immediately and that she was to cease all ex parte communications with _________________'s doctors and verification from _________________ this action was to cease was to be provided to Attorney _________________. A copy of said letter dated (Insert date), 20___, from _________________ to _________________ is attached hereto and marked as Exhibit "C" and asked to be incorporated herein as if fully set out in words and figures. 5. Thereafter, in (Insert month) 20____ defendant, _________________, continued to have ex parte communications with plaintiff, _________________, and continued to have ex parte communications with _________________'s treating physicians against the objections of plaintiff and his counsel. On (Insert date), 20___, Attorney _________________ wrote _________________, representative of the defendant, _________________, and advised her that she had failed to take action on his letter of (Insert date), 20___, and that she had failed to stop the conduct of _________________ and _________________, whom the defendant, _________________, had hired in the _________________ matter. COUNT ONE - 3 -6. Plaintiff sets his cause of action against the defendants as follows:A. The plaintiff incorporates all allegations set out in paragraphs 1 through 5 of this Complaint.B. The plaintiff charges the defendants, _________________, _________________ and _________________ with intentional interference with the attorney/client relationship between Attorney ______________ and client, _________________.C. As a direct and proximate result of the defendant's interference with the attorney/client relationship, the plaintiff, _________________, has sustained compensatory damages for wrongfully advising the plaintiff how to handle his claim, emotional and mental anguish, pain and suffering.D. The plaintiff states that the actions of the defendants in interfering with the attorney/client relationship were willful, wanton, malicious and obtrusive conduct on the part of the defendants and that punitive damages should be accessed against the defendants. COUNT TWO 7. Plaintiff incorporate by reference each and every allegation set forth in Count One, Paragraphs 1 through 6 of this Complaint. 8. The plaintiff alleges that the defendants have interfered with the plaintiff's patient/physician privilege with his treating physicians by conducting ex parte communications with treating physicians without the authorization of the plaintiff or his attorney. 9. As a direct and proximate result of the violation of the patient/physician privilege, the plaintiff, _________________, has sustained compensatory damages for interference with his treatment by his attending physician or physicians, and for compensatory damages for mental anxiety, pain and suffering as a result of the defendant's wrongful conduct. 10. - 4 - The plaintiff would state that the action and conduct of the defendants in interfering with the patient/physician privilege and confidentiality is willful, wanton, malicious and obtrusive conduct on the part of the defendants and that punitive damages should be accessed against the defendants for their wrongful conduct.WHEREFORE, PREMISES CONSIDERED plaintiff demands that a judgment for compensatory damages in a reasonable sum be entered against the defendants jointly and severally for the interference of the plaintiff's attorney/client relationship and the interference with the plaintiff's patient/physician privilege and confidentiality and that punitive damages be entered against the defendants for their willful, wanton, malicious, oppressive and grossly negligent conduct in a reasonable sum to be accessed by a jury at the trial of this cause, for all of which plaintiff demands that execution issue against the defendants as at law. Respectfully submitted,_______________________