Case 208Hee0C-48cv-Go67te"Document#e 4°-Fitee1.0/25/2129Page1 of 2,en
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`STATEOFWISCONSIN__CIRCUITCOURT__LACROSSE_— 09-01-2021
`Clerk of Circuit Court
`Brian Elder vs. Quartz Health Solutions, Inc.
`Electronic Filing
`Notice
`
`La Crosse County WI
`2021CV000448
`Honorable Elliott M Levine
`Branch 2
`
`Case No. 2021CV000448
`Class Code: Money Judgment
`
`QUARTZ HEALTH SOLUTIONS, INC.
`840 CAROLINA STREET
`SAUK CITY WI 53583
`
`—
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`—
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`Case number 2021CV000448 waselectronicallyfiled with/converted by the La Crosse County
`Circuit Court office. The electronicfiling system is designed to allow forfast,.réliableexchange
`of documents in court cases.
`
`Parties who register as electronic parties can file, receive and view documents online through
`the court electronic filing website. A documentfiled electronically has the samelegal effect as
`a documentfiled by traditional means. Electronic parties are responsible for serving
`non-electronic parties by traditional means.
`You may also register as an electronic party.by following the instructions found at
`http://efiling.wicourts.gov/ and may.withdraw.as an electronic party at any time. There is a
`$20.00 fee to register as an electronicparty. This fee may be waivedif yor file a Petition for
`
`If you are not represented by ¢an attorney and wouldlike to register an electronic party, you
`
`will need to enter.the following code on the eFiling website while opting in as an electronic
`party.
`-Pro Se opt-in code: dd9dib
`
`Unless you register as an electronic party, you will be served with traditional paper documents
`by other parties and by the court. You mustfile and servetraditional paper documents.
`
`Registration is available to attorneys, self-represented individuals, and filing agents who are
`authorized under Wis. Stat. 799.06(2). A user must register as an individual, not as a lawfirm,
`agency, corporation, or other group. Non-attorneyindividuals representing the interests of a
`business, such as garnishees, mustfile by traditional means or through an attorneyorfiling
`agent. More information about who mayparticipate in electronic filing is found on the court
`website.
`
`If you have questions regarding this notice, please contact the Clerk of Circuit Court at
`608-785-9590.
`
`La Crosse County Circuit Court
`Date: September 1, 2021
`
`GF-180(CCAP), 1 1/2020 Electronic Filing Notice
`
`This form shall not be modified. It may be supplemented with additional material.
`
`§801.18(5)(d), Wisconsin Statutes
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`

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`Case: 3:21-cv-00671 Document#: 4 Filed: 10/25/21 Page 2 of 9
`Case 2021CV000448
`Document 2
`Filed 09-01-2021
`Page 1 of 8
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`FILED
`09-01-2024
`Clerk of Circuit Court
`
`La Crosse County WI
`2021CV000448
`Honorable Elliott M Levine
`Branch 2
`
`STATE OF WISCONSIN
`
`CIRCUIT COURT
`
`LA CROSSE COUNTY
`
`
`
`BRIAN ELDER,
`2435 Lakeshore Drive
`
`La Crosse, WI 54603,
`
`vs.
`
`Plaintiff,
`
`Case No.
`Case Code: 30301, 30307
`
`QUARTZ HEALTH SOLUTIONS, INC.,
`840 Carolina Street
`Sauk City, WI 53583,
`
`Defendant.
`
`
`
`SUMMONS
`
`
`

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`Case 2021CV000448=Document2 Filed 09-01-2021 Page 2 of 8
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`THE STATE OF WISCONSIN,To the person named above as Defendant:
`
`You are hereby notified that the Plaintiff named above has filed a lawsuit or
`other legal action against you. The Complaint which is attached, states the nature and
`basis of the legal action.
`
`Within forty-five (45) days, you must respond with a written Answer, as that
`term is used in Chapter 802 of the Wisconsin Statutes, to the Complaint. The Court may
`reject or disregard an Answerthat does not follow the requirements of the statutes. The
`Answer must be sent or delivered to the Court, at La Crosse County Courthouse, 333
`
`Vine Street, La Crosse, WI 54601 and to James M.Burrows,Plaintiff's attorney, whose
`addressis listed below. You may have an attorney help or represent you.
`
`If you do not provide a proper Answer within forty-five (45) days, the Court
`may grant judgment against you for the award of moneyor otherlegal action requested
`in the Complaint, and you may lose yourright to object to anything that is or may be
`incorrect in the Complaint. A judgment may be enforced as provided by law. A
`judgment awarding money may becomea lien against any real estate you own now or
`in the future, and may also be enforced by garnishmentor seizure of property.
`
`BOSSHARD PARKELtd.
`
`s/ James M. Burrows
`
`James M. Burrows
`WIState Bar ID No. 1084705
`jburrows@bosshardparkelaw.com
`750 3rd Street N, Suite A
`
`P.O. Box 966
`
`La Crosse, WI 54602-0966
`Telephone: (608) 782-1469
`
`Attorneys for Plaintiff
`
`

`

`Case: 3:21-cv-00671 Document#: 4 Filed: 10/25/21 Page 4 of 9
`Case 2021CV000448
`Document 2
`Filed 09-01-2021
`Page 3 of 8 ne
`09-01-2021
`Clerk of Circuit Court
`
`La Crosse County WI
`2021CV000448
`Honorable Elliott M Levine
`Branch 2
`
`STATE OF WISCONSIN
`CIRCUIT COURT
`LA CROSSE COUNTY
`
`
`BRIAN ELDER,
`2435 Lakeshore Drive
`
`La Crosse, WI 54603,
`
`Vs.
`
`Plaintiff,
`
`Case No.
`Case Codes: 30301, 30701
`
`QUARTZ HEALTH SOLUTIONS,INC.,
`840 Carolina Street
`Sauk City, WI 53583,
`
`Defendant.
`
`
`COMPLAINT
`
`
`

`

`Case: 3:21-cv-00671 Document #: 4 Filed: 10/25/21 Page 5 of 9
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`Case 2021CV000448=Document 2 Filed 09-01-2021 Page 4 of 8
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`Plaintiff Brian Elder, by his attorneys, Bosshard Parke, Ltd., and as for his
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`Complaint against Defendant Quartz Health Solutions,Inc., alleges as follows:
`
`THE PARTIES
`
`L
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`Plaintiff Brian Elder (“Plaintiff” or “Elder’”) is an adult Wisconsin resident,
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`residing at 2435 Lakeshore Drive, La Crosse, Wisconsin 54603.
`
`2.
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`Defendant Quartz Health Solutions, Inc. (“Defendant” or “Quartz”) is a
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`Wisconsin corporation with, upon information andbelief, a principal place of business
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`located at 840 Carolina Street, Sauk City, Wisconsin 53583. Quartz is the insurer under
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`a policy for health insurance covering Plaintiff.
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`JURISDICTION AND VENUE
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`3,
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`The Court has general and specific jurisdiction over Defendant under Wis.
`
`Stat. §§ 801.05(1)(c), 801.05(5), and 801.05(10).
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`4,
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`Venueis proper in La Crosse County under Wis. Stat. §§ 801.50(2)(a).
`
`FACTUAL BACKGROUND
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`5,
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`In the fall of 2019, Plaintiff was hospitalized at Gundersen Lutheran
`
`Medical Center in La Crosse, Wisconsin (“Gundersen”) with an infection.
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`6.
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`Into his stay, on or about September 25, 2019, Gundersenstaff attempted
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`to discuss discharge planning —to a Skilled Nursing Facility (“SNF”)— with Plaintiff.
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`7.
`
`Dueto his infection, Plaintiff would need to be discharged to SNF with a
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`wound vac available for his use.
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`

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`Case 2021CV000448=Document 2 Filed 09-01-2021 Page 5 of 8
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`8.
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`When Gundersenstaff first approached Plaintiff about his discharge
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`planning, however, he was not medically stable to leave inpatient care at Gundersen.
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`9.
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`Indeed, on that same day, Plaintiff was examined by a neuropsychologist,
`
`Dr. Theresa Susmaras, wholatertestified that Plaintiff “appear[ed] to lack or have very
`
`diminished capacity on September 25.”
`
`10...
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`Dr. Susmaras further opined that Plaintiff “was not capable of engaging in
`
`the necessary mental processes to make informed medical decisions—including the
`
`decision for or against discharge from the hospital on that date.”
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`11.
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`The following day, Dr. Susmaras performed a neuropsychological exam
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`on Plaintiff, diagnosing him with a mild neurocognitive disorder.
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`12.
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`Nevertheless, on September 26, 2019, Dr. Susmaras observed Plaintiff's
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`mental state had “dramatically improved.”
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`13.
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`As a result, Dr. Susmarasrevisited Plaintiff's discharge plan with Plaintiff,
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`whoagreed to discharge to any nursing home within 25 miles, including Hillview
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`Health Care Center (“Hillview”), where Plaintiff had stayed prior to his hospitalization.
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`14.
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`Uponinformation andbelief, Hillview had a room and woundvac
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`available for Plaintiff later that day.
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`15.
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`Gundersen, however, informed Plaintiff that the first available nursing
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`home was Caledonia Rehab and Retirement (“Caledonia”), but Caledonia did not have
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`

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`Case 2021CV000448=Document 2 Filed 09-01-2021 Page 6 of 8
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`a wound vac available for Plaintiff. Once Caledonia received a woundvac, on October
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`3, 2019, Plaintiff was discharged from Gundersen.
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`16.
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`Plaintiff's bill for his stay at Gundersen was submitted to Quartz, who
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`denied coveragefor Plaintiff's stay for the period from September 25, 2019 through
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`October3, 2019.
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`17.
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`Quartz purportedly denied coverage because, according to Quartz, it was
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`“not medically necessary” under Plaintiff's health benefit plan.
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`18.
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`Plaintiff appealed that decision to Quartz’s Reconsideration Committee on
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`November1, 2019, who again declined to provide benefits under Plaintiff's health plan
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`for the services Gundersen provided from September 25, 2019 through October3, 2019.
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`19.
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`Quartz continues to deny Plaintiff benefits under his health plan despite
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`receiving the Dr. Susmaras’s affidavit.
`
`CLAIM I
`Declaratory Judgment under Wis.Stat. § 806.04
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`20.
`
`Plaintiff realleges and incorporates paragraphs 1 through 19 aboveasif
`
`fully set forth herein.
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`21.
`
`Quartz is the insurer undera health insurance policy issued to Brian Elder
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`(the “Policy”).
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`22.
`
`The Policy provides coverage for Elder's stay at Gundersen from
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`September25, 2019 through October3, 2019.
`
`23.
`
`Elder submitted a claim to Quartz, which Quartz wrongfully denied.
`
`

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`Case 2021CV000448=Document2 Filed 09-01-2021 Page 7 of 8
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`24.
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`A case or controversy, of justiciable nature, exists between Elder and
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`Quartz regarding Quartz’s obligations underthe Policy.
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`25.
`
`Elder is entitled to judgment declaring that the Policy provides coverage
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`for the services Gundersen provided Elder from September 25, 2019 through October 3,
`
`2019.
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`CLAIM II
`
`Breach of Contract
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`26.
`
`Plaintiff realleges and incorporates paragraphs 1 through 25 aboveasif
`
`fully set forth herein.
`
`27.
`
`28.
`
`The Policy is an enforceable contract between Quartz and Elder.
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`The Policy provides coverage for Elder’s stay at Gundersen from
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`September 25, 2019 through October3, 2019.
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`29.
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`By denying Elder’s claim, Quartz has materially breached theparties’
`
`contract.
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`30.
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`As a result of Quartz’s breach, Elder is entitled to compensatory damages
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`in an amount to be determined attrial.
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`CLAIM III
`Breach of the Implied Duty of Good Faith and Fair Dealing
`
`31.
`
`Plaintiff realleges and incorporates paragraphs 1 through 30 aboveasif
`
`fully set forth herein.
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`32.
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`The Policy implies a duty of good faith and fair dealing.
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`

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`Case: 3:21-cv-00671 Document#: 4 Filed: 10/25/21 Page 9 of 9
`Case 2021CV000448
`Document 2
`Filed 09-01-2021
`Page 8 of 8
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`33.
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`Quartz breached this implied duty by failing to consider Dr. Susmaras’s
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`opinions regarding Elder’s lack of capacity when denying coverage underthe Policy.
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`34.
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`Asa result of Quartz’s breach, Elderis entitled to compensatory damages
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`in an amountto be determined attrial.
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`PRAYER FOR RELIEF
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`WHEREFORE,Plaintiff respectfully requests the followingrelief:
`
`Bs
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`Judgmentagainst Quartz declaring that the Policy provides coverage for
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`the services Gundersen provided Elder from September 25, 2019 through October 3,
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`2019;
`
`B.
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`C.
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`D,
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`Compensatory damages in an amountto be determinedattrial;
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`An awardofPlaintiff’s reasonable expenses, including attorneys’ fees; and
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`Anyfurther relief the Court deemsjust and equitable.
`
`Dated this 1st day of September, 2021.
`
`BOSSHARDPARKELtd.
`
`s/ James M. Burrows
`James M. Burrows
`WIState Bar ID No. 1084705
`jburrows@bosshardparkelaw.com
`750 3rd Street N, Suite A
`P.O. Box 966
`
`La Crosse, WI 54602-0966
`Telephone:(608) 782-1469
`
`Attorneys for Plaintiff
`
`