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IN THE CIRCUIT COURT OF COUNTY, MISSISSIPPI AND PLAINTIFFSVS. NO. DEFENDANT ANSWER files this Answer and responds to the Complaint as follows: AFFIRMATIVE DEFENSES FIRST DEFENSE Plaintiff fails to state a claim against upon which relief can be granted. SECOND DEFENSE affirmatively states that payment of all claims referenced in the Complaint have
been properly paid in accordance with the terms and conditions of the policy in issue. THIRD DEFENSE has, at all times, had a reasonable and arguable basis for the non-payment of the
Plaintiffs' claims in this matter. FOURTH DEFENSE conducted a reasonable investigation of the circumstances relating to the claims
in issue and relied upon the independent objective opinion of an outside consulting physician in
affirming the denial of benefits. FIFTH DEFENSE Any assessment of punitive damages against would violate the provisions of the
Constitution of the United States, including the Fifth, Eighth, and Fourteen, Amendments, and
would also violate the provisions of the Constitution of the State of Mississippi, including
Sections 14, 16, 17, and 28. SIXTH DEFENSE
responds to the numbered paragraphs of the Complaint in sequence and
incorporates its affirmative defenses states above.I. Admitted.II.Admitted.III. admits the Plaintiff's medical records indicate he/she sustained his/her
injury on or about , , in the manner set forth in the Complaint. admits
that the Plaintiff's medical records indicate he/she saw Dr. on or about ,
6, in connection with this injury. further admits that the medical records indicate
was admitted to on , until he/she was discharged on ,
66.IV. admits that the medical records indicate that Plaintiff saw Dr.
on or about , , complaining of continued pain in connection with the injury
complained of in this action. further admits that Dr. admitted Plaintiff to
666 on , , and that he/she was discharged on , .V. admits that claims were submitted to it by Drs. and and by
666, which claims were paid pursuant to the terms of the policy. admits it did not pay the
claim from for the hospitalization charges because hospitalization was not medically
necessary. All remaining allegations or fact are denied.VI. admits it paid Dr. 's claim and that it did not pay the claim of .
Again, affirmatively states that the hospitalization was not medically necessary pursuant
to the terms of the policy and, thus, was not covered. denies that the Plaintiff
obtained pre- certification for his/her entire stay at . specifically denied
pre-certification for each day of the hospitalization except for a preliminary pre-certification for
, , based on the oral representations relayed to by representatives of
666 that certain treatment would be provided to the Plaintiff . After review of the medical
records, confirmed the appropriateness of denial of pre-certification for each day except
6666 , and further determined that actual treatment for was not medically
necessary for inpatient care.VII. admits that the Plaintiffs contacted it on several occasions concerning the
denial of the hospital claim. denies that the Plaintiffs were ever led to believe that the
claim would be paid. specifically denied pre-certification for each day of the
hospitalization except for a preliminary pre-certification for , , based on the
oral representations relayed to by representatives of that certain treatment would be
provided to the Plaintiff . admits that on , , that it forwarded
Plaintiffs a letter informing them that the denial of the claims had been reviewed internally as
well as by an outside consulting physician and that the outside consulting physician's opinion
was that the hospitalization was not medically necessary. denies that the Plaintiff
obtained pre-certification for his/her entire stay at .
VIII.Admitted. denies that the Plaintiff is entitled to the relief sought in the
Complaint or to any relief whatsoever.WHEREFORE, requests that the Plaintiffs' Complaint be dismissed with prejudice
and all costs be taxed to the Plaintiffs. additionally requests all further relief the Court
may deem proper.DATED, this the day of , . Respectfully submitted, ______________________________________________BY: CERTIFICATE OF SERVICE I, , hereby certify that I have this day caused to be mailed by United States mail,
postage prepaid, a true and correct copy of the above and foregoing ANSWER to the following
counsel of record: This the day of , . _____________________________
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