UNITED STATES DISTRICT COURT

FOR THE SOUTHERN DISTRICT OF OHIO

EASTERN DIVISION

PARK NATIONAL CORPORATION

50 N. 3rd Street

Newark, OH 43055,

Plaintiff,

v.

HCC LIFE INSURANCE COMPANY, n/k/a 

TOKIO MARINE HCC

225 TownPark Drive, Suite 350

Kennesaw, GA 30144,

Defendant.

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CASE NO. _____________________

JUDGE: _______________________

(JURY DEMAND ENDORSED HEREON)

COMPLAINT

BACKGROUND

1. This is a 28 U.S.C. §1332 diversity-based federal civil action by Park National Corporation 

(which funds and sponsors a self-insured employee welfare benefit plan) against a stop 

loss insurance carrier that has breached, and continues to breach a Contract providing for 

the reimbursement of stop loss insurance monies and benefits. The employer, Park 

National Corporation, the mutually agreed-upon benefit Plan Utilization Review Vendor 

(InVentive Medical Management), and the benefit Plan’s third-party administrator 

(Medical Benefits Administrators, Inc.), all agree and concur that the stop loss benefits 

sought in the Complaint are due and owing to Park National Corporation.

VENUE AND JURISDICTION

2. Jurisdiction property exists with this Court under 28 U.S.C. § 1332 in that Plaintiff Park 

National Corporation and Defendant Tokio Marine HCC, f/k/a HCC Life Insurance 

Company are citizens of different states and the amount in controversy exceeds Seventy 

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Five Thousand Dollars ($75,000.00), exclusive of interest and costs. This action is properly 

venued in this Court because Plaintiff Park National Corporation maintains its principal 

place of business in Newark, Licking County, Ohio; because the Contract at issue was 

entered into and executed in Newark, Licking County, Ohio; and because the underlying 

events giving rise to the breach by Defendant Tokio Marine HCC, f/k/a HCC Life Insurance 

Company occurred in Newark, Licking County, Ohio. 

COMMON ALLEGATIONS

3. Park National Corporation (“Park National Corp.” or “Plaintiff”) is a Delaware corporation 

having its principal place of business at 50 N. 3rd Street, Newark, Ohio 43055. Park 

National Corp. does business as, inter alia, Park National Bank, Century National Bank, 

Fairfield National Bank, Farmers Bank, First-Knox National Bank, Richland Bank, Second 

National Bank, Security National Bank, United Bank, and Unity National Bank. All of the 

above-mentioned community banks have their principal places of business within the 

State of Ohio. 

4. HCC Life Insurance Company, n/k/a Tokio Marine HCC (“HCC Life Insurance” or 

“Defendant”) is an Indiana-incorporated insurance company that makes available, and 

offers stop loss insurance benefits and coverages to self-insured welfare benefit plans. 

HCC Life Insurance maintains its principal place of business at 225 TownPark Drive, Suite 

350, Kennesaw, GA 30144. The Ohio registered agent for service of process for HCC Life 

Insurance is National Registered Agents, Inc., 4400 Easton Commons Way, Suite 125, 

Columbus, OH 43219.

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5. The Park National Corporation Employee Health Benefit Plan – Wellness Plan (“the Plan”) 

is a self-funded employer welfare benefit plan that provides, and makes available 

hospitalization, medical, surgical, and prescription drug benefits for enrolled employeeparticipants, spouses, and eligible dependents of employees of Park National Corp. and 

the community banks listed in paragraph 3 of the Complaint. The Park National 

Corporation Employee Health Benefit Plan – Wellness Plan is sponsored and funded by 

Park National Corp., and is the vehicle by which Park National Corp. makes available 

welfare benefits to employees, spouses and eligible dependents, and remits payments to 

medical service providers of such persons.

6. Effective October 1, 2013 through September 30, 2014, Park National Corp. entered into, 

and had in place stop loss insurance for the Park National Corporation Employee Health 

Benefit Plan – Wellness Plan, and the some 1,260 participants, spouses and eligible 

dependents enrolled in the Plan. The stop loss insurance Contract with HCC Life Insurance 

provided for a Two Hundred Thousand Dollars ($200,000.00) deductible per Covered 

Person, after which stop loss reimbursement would be at one-hundred percent (100%). 

The stop loss insurance maintained between Park National Corp. and HCC Life Insurance 

was comprised of the Application; the HCC Life Insurance Stop Loss Policy; and the Park 

National Corporation Employee Health Benefit Plan – Wellness Plan, all of which 

comprised and constituted the “Contract” per the defined terms of the HCC Life Insurance 

Company stop loss insurance policy. A complete and accurate copy of the HCC Life 

Insurance/Park National Corp. stop loss insurance application is attached hereto, and 

incorporated herein as Exhibit “A”. A complete and accurate copy of the HCC Life 

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Insurance/Park National Corp. stop loss insurance policy and accompanying 

endorsementsis attached hereto, and incorporated herein as Exhibit “B”. A complete and 

accurate copy of the HCC Life Insurance/Park National Corp. Employee Health Benefit Plan 

– Wellness Plan is attached hereto, and incorporated herein as Exhibit “C”. At all times 

material herein, Park National Corp. remitted the requisite premiums and fulfilled all 

conditions of the “Contract” so as to maintain its stop loss insurance policy and coverages.

7. The HCC Life Insurance/Park National Corp. stop loss insurance policy required that HCC 

Life Insurance and Park National Corp. mutually agree on a Utilization Review Vendor, and 

for purposes of the “Contract”, HCC Life Insurance and Park National Corp. selected 

InVentive Medical Management as the Utilization Review Vendor.

8. The HCC Life Insurance/Park National Corp. stop loss insurance policy required HCC Life 

Insurance and Park National Corp. to mutually agree upon a “Plan Supervisor” to serve as 

the third-party administrator of the Plan. Under the “Contract”, HCC Life Insurance and 

Park National Corp. selected Medical Benefits Administrators, Inc. as the Plan Supervisor 

for the Plan and the stop loss insurance policy. 

9. The HCC Life Insurance/Park National Corp. stop loss insurance policy provided, inter alia:

NON-PARTICIPATING INSURANCE

This is a reimbursement policy. You, or Your Plan Supervisor, are 

responsible for making benefit determinations under Your 

Employee Benefit Plan. We have no duty or authority to 

administer, settle, adjust, or provide advice regarding claims filed 

under Your Employee Benefit Plan. 

10. The Park National Corp. Employee Health Benefit Plan – Wellness Plan provided, inter 

alia:

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4.8 PLAN ADMINISTRATOR DISCRETION

Nothing in this Plan precludes the Plan Administrator from 

exercising full discretionary authority and responsibility with 

respect to all aspects of Plan administration and interpretation. The 

Plan Administrator shall have all powers necessary to carry out the 

purposes of the Plan, including supplying any omissions in 

accordance with the intent of the Plan and deciding all questions 

concerning eligibility for participation in the Plan and concerning 

the amount of benefits payable to a Covered Person. 

11. On March 8, 2014, Park National Bank employee Ms. April Prather gave birth, 

prematurely, to baby Micah Prather at Cincinnati Children’s Hospital. At all times material 

herein, April Prather and Micah Prather were eligible “Covered Persons” under the 

“Contract” and the Plan. 

12. Baby Micah Prather underwent multiple surgeries and other life-saving medical 

procedures and treatment in Level IV and Level III neonatal care at Cincinnati Children’s 

Hospital while the HCC Life Insurance/Park National Corp. stop loss insurance policy and 

the “Contract” was in force and effect. While receiving Level IV and Level III neonatal 

intensive care treatment at Cincinnati Children’s Hospital, Utilization Review Vendor 

InVentive Medical Management issued at least three “medical necessity” written 

determinations wherein InVentive Medical Management held and determined that all of 

the care and treatment afforded to baby Micah Prather was appropriate, and that all of 

the itemized bills were similarly appropriate and “customary and reasonable” for a 

critically-ill newborn infant with multiple life-threatening issues. Plan Supervisor Medical 

Benefits Administrators, Inc. also reviewed, analyzed and considered the care, treatment 

and service invoices for baby Micah Prather, and similarly held and determined that all 

were medically necessary, and customary and reasonable. 

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13. Notwithstanding the covered care and treatment rendered to baby Micah Prather, and 

notwithstanding the assessments and determinations by InVentive Medical Management 

and Medical Benefits Administrators, Inc., HCC Life Insurance rejected, and refused to 

reimburse Park National Corp. Two Hundred Sixty Six Thousand Nine Hundred Sixty Six 

Dollars and Forty-Two Cents ($266,966.42) in covered and invoiced expenses that were 

paid, and payable under the Plan and the “Contract”. Park National Corp., through the 

Plan, remitted the $266,966.42 sum to the Cincinnati Children’s Hospital. The 

$266,966.42 remitted by Park National Corp. through the Plan to the Cincinnati Children’s 

Hospital was an amount that remained after the Contract’s and the stop loss insurance’s 

deductible had been met and satisfied.

14. On December 8, 2014, HCC Life Insurance hired and paid Norman S. Kato, M.D. to author 

a clinical review of the care, treatment and services rendered to baby Micah Prather, and 

the accompanying invoiced charges. Dr. Kato’s clinical review continued to insist that 

$266,966.42 in charges for the care and treatment of baby Micah Prather were not

“medically necessary” and therefore not reimbursable to Park National Corp. Dr. Kato’s 

clinical review referenced care and treatment rendered at Children’s Hospital Medical 

Center in Chicago, Illinois and was predicated solely on the “medical necessity” of the 

covered and invoiced expenses, and not whether such expenses were “customary and 

reasonable”. Furthermore, Dr. Kato’s clinical review quoted and invoked language from 

the non-existent, inoperable First Knox National Bank Medicare Supplemental Plan 

Summary Plan Description, whereas Ms. April Prather, and baby Micah Prather were 

covered under the separate Plan. The inoperable, non-existent First Knox National Bank 

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Medicare Supplemental Plan was at one time available for retirees of the First Knox 

National Bank. Neither Ms. April Prather nor her baby Micah Prather were retirees of the 

First Knox National Bank.

15. Medical Benefits Administrators, Inc., on behalf of Park National Corp., administratively

appealed HCC Life Insurance’s adverse reimbursement determination on January 21, 

2015. On January 22, 2015, HCC Life Insurance rejected the filed administrative appeal, 

this time claiming and asserting that the charges for the care and treatment of baby Micah 

Prather were not “usual, reasonable, and customary”. HCC Life Insurance’s rejection of 

the filed administrative appeal asserted that it was based on “...the report completed by 

Avandè and Dr. Norman S. Kato, M.D.”

16. Park National Corp. has exhausted all administrative avenues of relief as a perquisite to 

this suit and action. 

COUNT I – BREACH OF CONTRACT

17. Plaintiff restates and reavers its claims and allegations set forth in paragraphs 1-16 of this, 

its Complaint.

18. By and through the above-described actions, HCC Life Insurance has breached, and 

continues to breach the “Contract” and stop loss insurance policy that HCC Life Insurance 

entered into with Park National Corp. HCC Life Insurance’s breach, and continued breach, 

has caused Park National Corp. to suffer and experience monetary damages in the 

amount of Two Hundred Sixty Six Thousand Nine Hundred Sixty Six Dollars and Forty Two 

Cents ($266,966.42), plus interest, for which Park National Corp. is entitled to relief from 

this Court.

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COUNT II – DECLARATORY JUDGMENT

19. Plaintiff restates and reavers its claims and allegations set forth in paragraphs 1-18 of this, 

its Complaint.

20. There exists and actual, and justiciable controversy between HCC Life Insurance and Park 

National Corp., for which Park National Corp. is entitled to declaratory relief by this Court 

defining the rights, obligations and available relief as between HCC Life Insurance and 

Park National Corp. Park National Corp. is entitled to a declaratory judgment that the 

“Contract” and the stop loss insurance policy requires HCC Life Insurance to fully 

reimburse Park National Corp.

COUNT III – INJUNCTION

21. Plaintiff restates and reavers its claims and allegations set forth in paragraphs 1-20 of 

this, its Complaint.

22. HCC Life Insurance Company has failed, and continues to fail to follow and adhere to the 

“Contract” and the stop loss insurance policy.

23. As a result of HCC Life Insurance’s actions, inactions, and conduct, Park National Corp. is 

entitled to injunctive relief from this Court, ordering HCC Life Insurance Company to 

follow, and to adhere to the “Contract” and stop loss insurance policy. 

COUNT IV – TORTIOUS BAD FAITH INSURANCE DENIAL

24. Plaintiff restates and reavers its claims and allegations set forth in paragraphs 1-23 of this, 

its Complaint.

25. The actions, inactions and conduct described herein by HCC Life Insurance was arbitrary, 

capricious, without rationale or reasoning, and malicious. 

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26. The actions, inactions and conduct of HCC Life Insurance Company constitute tortious, 

bad faith denial of insurance claims and benefits for which Park National Corp. seeks 

injunctive and monetary relief, in addition to punitive damages.

WHEREFORE, Plaintiff respectfully prays that this Court:

1. Enter an order awarding Plaintiff’s Two Hundred Sixty Six Thousand Nine Hundred Sixty 

Six Dollars and Forty-Two Cents ($266,966.42), with interest and expended costs;

2. Enter a declaratory judgment that Defendant HCC Life Insurance has breached, and 

continues to breach the “Contract”, and the stop loss insurance policy;

3. Enter an injunction prohibiting HCC Life Insurance Company from breaching, and 

continuing to breach the “Contract”, and the stop loss insurance policy;

4. Award Plaintiff punitive damages in an amount determined, and to be determined, by a 

jury;

5. Award Plaintiff recovery of its expended costs and attorneys’ fees; and

6. Award all such further relief as the Court deems just, proper and equitable. 

Respectfully submitted,

s/Keith L. Pryatel

Keith L. Pryatel (#0034532)

kpryatel@kwwlaborlaw.com

(Trial Counsel)

Kenneth M. Haneline (#0037017)

khaneline@kwwlaborlaw.com

KASTNER WESTMAN & WILKINS, LLC

3550 West Market Street, Suite 100

Akron, OH 44333

330.867.9998 (phone)

330.867.3786 (fax)

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