September 2003 Case Notes:

Automobile Insurance Law

Insurance Bad Faith

Medical Malpractice

Special Needs Trusts

Auto Insurance Case Notes

by Scott B. Cooper, Esq.

Scott Cooper, an associate in the firm of Schmidt, Ronca & Kramer, P.C., Harrisburg, is a member of PaTLA’s Board of Governors.

Waiver of stacking only applies to intra-policy stacking and not inter-policy stacking. State Farm Mut. Auto. Ins. Co. v. Rizzo, —- A.2d —- (Pa. Super. Sept. 24, 2003).

Sandra Rizzo (“Rizzo”) was injured in a motor vehicle accident while riding in a vehicle that hydroplaned causing the vehicle to crash through a guardrail and roll down an embankment.  The insurance company for the vehicle’s operator conceded fault and tendered the liability insurance coverage on the vehicle she was occupying.  Following the priority of underinsured motorist coverage established in 75 Pa.C.S.A. §1733, Rizzo first sought underinsured motorist benefits under her own motor vehicle insurance policy with State Farm Mutual Automobile Insurance Company (“State Farm”).  She had only one vehicle on the policy, which provided $15,000 per person/$30,000 per accident underinsured motorist coverage (“UIM”) and State Farm tendered the UIM limits.  She had signed a waiver rejecting stacking on her policy, but only had one vehicle on the policy.

Pursuant to §1733, she then sought a second level of UIM coverage on her father’s policy with State Farm, since she qualified as a resident relative under his policy.  Her father’s policy provided for $15,000 per person/$30,000 per accident UIM coverage.  State Farm initially denied coverage based upon the “household exclusion” in her father’s policy but then later agreed that the exclusion did not apply since Rizzo was an occupant of another vehicle that was not garaged in the household at the time of the accident.  However, State Farm still denied coverage because both Rizzo and her father executed waivers of stacking on their single vehicle policies.  The trial court granted State Farm’s motion for declaratory relief and determined that stacking had been waived.  Rizzo appealed.

The Superior Court, in a decision authored by Judge Kate Ford Elliott, concluded that an individual who owns only one vehicle may not be considered to have waived stacking on other motor vehicle policies in his/her household that may also provide for uninsured or underinsured motorist coverage.  Thus, the court held that the waiver of stacking form in §1738 of the Pennsylvania Motor Vehicle Financial Responsibility Law (“MVFRL”) only applies to intra-policy stacking and not inter-policy stacking.

The court cited its decision in In Re Insurance Stacking Litigation (“Stacking Litigation”), 754 A.2d 702 (Pa. Super. 2000) where several insureds challenged the insurer’s right to charge them for stacked uninsured and underinsured motorist coverage when each of the insureds owned only one vehicle that was insured under one policy. The Insurance Commissioner found the insurer’s practice lawful. The trial court determined that the insured’s company’s practice was lawful and the insureds appealed.  The court in Stacking Litigation determined that insurance companies are allowed to charge a premium for stacking with policies insuring only one vehicle.  In Rizzo, State Farm argued that based upon the Stacking Litigation decision, the Insurance Commissioner’s decision was upheld and therefore, both Rizzos who waived stacking were ineligible for stacking because the Insurance Commissioner previously determined that both intra-policy and inter-policy stacking could be waived pursuant to §1738. 

However, the court noted that State Farm “apparently misread” the opinion in Stacking Litigation. The Stacking Litigation court wrote that there is an inherent ambiguity between §1738(b) of the MVFRL, which allows an insured to waive stacking, and §1738(c), which permits those entitled to notice of an opportunity to waive to those who purchase uninsured or underinsured coverage “for more than one vehicle under a policy.” Stacking Litigation, 754 A.2d at 708.

In Stacking Litigation, the court found that “only named insureds who purchase coverage for more than one vehicle under a single policy will be entitled to notice and the opportunity to waive stacking...the Legislature only intended to allow named insureds who have more than one vehicle insured under a policy to waive stacking.”  Id. at 708.  The court in Stacking Litigation went on to further find that §1738(b), (c) and (d) must be construed together such that only named insureds who purchase coverage for more than one vehicle under a policy may waive the stacking of uninsured or underinsured benefits. Id. at 709.  The court also referred to a recent Superior Court opinion, Nationwide Mut. Ins. Co. v. Harris, 826 A.2d 880, 883-84 (Pa.Super. 2003), where it also interpreted the Stacking Litigation court’s analysis of §1738 and decided that an insured may not waive the right to inter-policy stacking; only intra-policy stacking may be waived.

The court concluded that the Rizzos could not waive stacking because neither of them insured more than one vehicle under their policies and, thus, they could not intra-policy stack.  Judge Ford Elliott wrote that even though the Rizzos paid reduced premiums for a waiver of stacking, their election, was “void ab nitio and therefore unenforceable because it conflicted with the provisions of §1738 as this court has interpreted it.”  Thus, stacking is allowed to the Rizzos.

The applicability of a “set-off” clause is also addressed because State Farm argued that it reduced the amount of UIM coverage that could be recovered on the second level of coverage to the highest amount of underinsured coverage available to the insured.  The court found that the set-off clause is an attempt to limit the insured’s recovery of underinsured benefits.  Therefore, if valid, since Rizzo’s father elected only $15,000 in underinsured coverage, she would be entitled to nothing from her father’s policy since she already received $15,000 in underinsured benefits from her own policy.

The Rizzos cited the Superior Court decision in Allwein v. Donegal Mut. Ins. Co., 671 A.2d 744 (en banc), appeal denied, 685 A.2d 541 (Pa. 1996) where the court held that §1702 of the MVFRL clearly expresses the policy of the commonwealth in favor of excess underinsured and uninsured insurance versus gap uninsured and underinsured insurance and that neither the insurer nor the court has the power to render the statutory enactment otherwise.  State Farm relied upon the Superior Court opinion in Bowersox v. Progressive Cas. Ins. Co., 781 A.2d 1236 (Pa.Super. 2001), appeal denied, 806 A.2d 857 (Pa. 2002) where the Superior Court held that a clause in an insurance contract setting off otherwise available underinsured benefits was enforceable.
The court held that Bowersox was inapposite “as it involved an attempt to receive UIM benefits under the same policy insurance from which an insurer had already paid first party liability benefits.”  The set-off clause is invalid and the judgment entered in favor of State Farm is vacated and judgment entered in favor of Rizzo. n

A self-insured entity is not required, as a matter of law, to provide uninsured motorist benefits pursuant to the Pennsylvania Motor Vehicle Financial Responsibility Law when a valid uninsured rejection form is signed by the renter. Smith v. Enterprise Leasing Co. of Philadelphia, —- A.2d —- (Pa. Super. Sept. 24, 2003).

Sharmetha Smith (“Smith”) rented a vehicle from Enterprise Rental Car (“Enterprise”) and signed a rental agreement.  Her signature on the rental contract appeared under printed terms that stated “I have read and agree to the terms and conditions on both sides of this agreement.”  The reverse side of the contract agreement contained language rejecting uninsured motorist coverage, which complied with the rejection language and form in the Pennsylvania Motor Vehicle Financial Responsibility Law (“MVFRL”) under §1731. 
The Smiths, while occupants of the rented vehicle, were involved in an accident with another vehicle operated by an uninsured driver.  The Smiths made a claim for uninsured motorist (“UM”) benefits from Enterprise, arguing that, pursuant to the provisions of the MVFRL, as a matter of law, they were required to receive UM coverage despite the rejection of the coverage in the rental agreement.  The trial court found in favor of the Smiths, and Enterprise appealed.

The Superior Court opinion authored by Judge Beck discusses the “interplay” between §1787 and 1731 of the MVFRL.  The court noted that under §1787 (a)(3), Enterprise is required as a self-insured to provide uninsured motorist coverage to its customers.  However, under §1731, an insured may reject uninsured motorist coverage by executing the proper rejection form.

The Superior Court acknowledged that “at first blush” the decision in Gutman v. Worldwide Ins. Co., 630 A.2d 1263 (Pa. Super. 1993) appeared to control the case.  In Gutman, the Superior Court determined that self-insurers are required to provide the minimum amount of uninsured motorist coverage despite the fact that optional provisions were only recently enacted for purposes of liability coverage.  However, Enterprise argued, and the court agreed, that Gutman no longer applies because §1731 has been amended.  Specifically, §1731, when it was amended, added language allowing for the rejection of UM coverage, which includes “any policy of insurance or self-insurance issued under this agreement”.  Therefore, Enterprise argued that since the statutory provision expands upon all the language relating to self-insureds in §1787(a)(3) and the Smiths signed the rental agreement with the required rejection language, the waiver of uninsured motorist coverage is valid. 

The Superior Court agreed with this rationale and argument.  The court concluded that the Smiths signed a valid waiver of UM benefits in a form required by §1731(b.1).  It rejected any argument that “her signature appeared on the reverse side of the waiver” made the rejection invalid.  See Kline v. Old Guard Ins. Co., 820 A.2d 783 (Pa. Super. 2003).  The trial court’s order granting Summary Judgment in favor of the Smiths is reversed and the case remanded.

Household exclusion valid and does not violate public policy based on facts of the case. Seiler v. American International Ins. Co., 2003 WL 21989999 (3rd Cir. Pa. Aug. 21, 2003) (Not precedential).

Robert Roberts (“Roberts”) was killed in a motor vehicle accident on June 13, 1999, when the car he was driving was struck head-on by an underinsured drunk driver.  At the time of the accident, Roberts was driving a 1990 Mazda that was owned by his wife (“Seiler”) because his own car, a 1995 Dodge, was being repaired.  His wife’s car was insured with State Farm. His car was insured by American International Ins. Co.  (“American”).  Seiler on behalf of his Estate recovered the third-party coverage from the drunk driver’s insurance policy and settled for the policy limits of underinsured motorist (“UIM”) coverage on the policy for the 1990 Mazda he was operating at the time of the accident. 

After recovering the first level of UIM coverage, a claim was made to American for UIM coverage under the policy Roberts purchased for the 1995 Dodge.  American denied payment, arguing that the “household exclusion” applied because the accident involving his wife’s car was garaged and insured in the household but not covered on the American insurance policy.  Seiler filed suit against American seeking a declaratory judgment action requiring UIM benefits to be paid on the American policy. 

American filed a Motion for Summary Judgment on the ground that it was not obligated to pay benefits due to the household exclusion.  This court ruled that the household exclusion applied and Seiler appealed. 
The insurance policy provision in reference provided in part:

We do not provide Underinsured Motorists Coverage for ‘bodily injury’ sustained:
1. By you while ‘occupying’ … any motor vehicle you own which is not insured for this coverage under this policy …
The policy defines “you” as:
1. The “named insured” shown in the Declarations; and
2. The spouse if a resident of the same household.

No argument is made by either side that the policy language is unclear or ambiguous.  Seiler argued that the policy restriction was not applicable because its definition of “you” includes a spouse, which is not consistent with terms of the MVFRL.  Seiler contended that American’s definition of “you” renders title to a vehicle irrelevant by providing that an insured is the owner of any vehicle owned by his spouse who resides in the same household (even if an insured is not “co-owner of a spouse’s car”.)

The Third Circuit panel rejected that argument for two reasons.  First, the court found that Seiler did not raise the argument at the district court level and did not preserve the issue for review.  Second, even if the argument was preserved, the court found the definition used by American does not conflict with any of the definitions in the relevant chapters and Title 75.

The second argument, and the main contention, was the enforceability of the household exclusion.  Seiler claimed that the case was not like other cases because Roberts actually paid for the policy under which Seiler was seeking UIM benefits and because both of the cars in the household had the same level of UIM coverage.  The court rejected Seiler’s assertion that the case was factually different from any other cases.  The court reviewed the various reasons to set aside the “household exclusion” in the Seiler policy as well as the cases of Burstein v. Prudential Prop. & Cas. Ins. Co., 809 A.2d 204 (Pa. 2002), Old Guard Ins. Co. v. Houck, 801 A.2d 559 (Pa. Super. 2002), appealed denied, 818 A.2d 505 (Pa. 2003) and Nationwide Mut. Ins. Co. v. Ridder, 105 F.Supp.2d 434 (E.D. Pa. 2000).  It concluded that there was no public policy violated in this particular case to set aside the household exclusion.

The court noted that, “just as in Ridder, Seiler chose the benefits for the Mazda that the deceased was driving at the time of the accident.  Like her deceased husband, she could have chosen significantly higher UIM coverage and, accordingly, could have paid higher premiums, but she did not.  To require American to pay UIM benefits in this instance would require the company to underwrite a risk which it had not contracted.  This would allow a policyholder to receive benefits far in excess of that for which she paid…Accordingly, we find no public policy violation in enforcing the exclusion under the facts presented in this case.”
The court affirmed the District Court decision granting Summary Judgment to American.

Insurance Bad Faith Case Notes

by Joseph F. Roda, Esq.

Joseph Roda, a partner in the firm of Roda & Nast, P.C., of Lancaster, is Chair of PaTLA’s Insurance Bad Faith Section


Evidence of insurer’s false responses to discovery and pleadings in subrogation action held inadmissible.  W. V. Realty, Inc. v. Northern Insurance Co., No. 02-2910 (3d Cir. June 27, 2023)(Barry, J.).

In W. V. Realty, Inc. v. Northern Insurance Co., the plaintiff served interrogatories requesting information about other, similar bad faith cases brought against the insurer, and the insurer responded that no such cases existed.  The plaintiff learned that this was false, and obtained sanctions against the insurer.  At trial, the plaintiff was allowed to introduce evidence that the insurer had responded falsely to the interrogatories, that hundreds of similar bad faith claims had been brought against the insurer, and that the insurer had been sanctioned for its false response.

The jury awarded punitive damages against the insurer and the trial court denied the insurer’s motion for new trial.
The Court of Appeals reversed, holding that the insurer’s false discovery response was not relevant to the plaintiff’s bad faith claim, because there was no evidence that the insurer had given this response for the purpose of delaying payment of the underlying claim.  The court further held that the probative value of the evidence was substantially outweighed by its prejudicial effect, because the jury may have concluded that other bad faith claims against the insurer made it more likely that the insurer had handled the plaintiff’s underlying claim in bad faith.  Moreover, the court noted, the district court did not tell the jury that it could consider only the discovery violation, not the fact that there were other bad faith cases against Northern.  

The Court of Appeals also held that the district court erred in admitting evidence that the insurer had alleged, in a subrogation action, that it had paid $1.2 million to the plaintiffs, when the insurer at that time had actually paid only $318,000.  The insurer’s pleading, the court held, was not evidence of bad faith, because the insurer’s recovery in the subrogation action was limited to what it actually paid to the plaintiff, and the pleading merely served to protect the insurer’s interest in recovering all amounts that it might be required to pay. 

Lawrence County court adopts two-year statute of limitations for statutory bad faith actions.  Ash v. Continental Insurance Company, No. 10492 of 2002 (C.P. Lawrence. Sept. 15, 2003)(Motto, J.)

In Ash v. Continental Insurance Company, the plaintiffs filed a breach of contract claim to recover benefits under a homeowners’ policy and the insurer moved for summary judgment, arguing that the claim was barred by the one-year limitations period in the insurance policy. In response, the plaintiffs moved to amend their complaint to add a claim for bad faith under §8371. 
The insurer argued that this claim was also time-barred under the two year limitations period for tort claims, and the plaintiffs argued that the four-year period applicable to contract claims applied. 

The court held that the four-year period was inapplicable because the prohibition of bad faith “has no roots in the contract itself, but arises directly from societal expectations completely independent of any contract.”  “The very basis for the creation of the bad faith cause of action,” the court held, “is beyond the domain of the law of contracts and well into the domain of the law of torts.”

The court did not mention any of the cases, holding that the obligation to act in good faith is an implicit term of every contract.
 The court also rejected the six-year limitation period, and concluded that a two-year period applied.  In support of this decision, the court noted that §8371 was enacted in response to D’Ambrosia v. Pennsylvania  Nat’l Mutual Ins. Cas. Co., in which the  state Supreme Court declined to create a “new tort” of bad faith.  The court also observed that punitive damages are typically only available in tort actions, and that a bad faith claim is based upon a standard imposed by society, consistent with a tort claim. 

Bad faith claim not barred by statute of limitations; emotional distress claim not precluded. Hatchigian v. Hartford Insurance Company, No. 03-3252 (C.P. E.D. Pa. August 13, 2023)(Buckwalter, J.)

In Hatchigian v. Hartford Insurance Company, the plaintiff made a claim for wage loss benefits after a motor vehicle accident, and the insurer, after a period of delay, sent him $6,009.60, accompanied by a letter saying that it “consider[ed] the matter closed.”  The insurer later conceded, however, that it owed the plaintiff an additional $468.80, and paid that amount.  The plaintiff then demanded an additional $7,628.63, and asked the insurer to respond to this demand within 45 days, in accordance with 31 Pa. Code §146.6.  The insurer did not respond.

The plaintiff subsequently filed a bad faith claim, and the insurer filed a motion to dismiss that claim based on the statute of limitations.  The insurer argued that the limitation period commenced when the insurer advised that it “consider[ed] the matter closed.”  The court disagreed, however, because the insurer’s subsequent payment showed that the matter was not “closed.”  Thus, the court concluded, the limitation period did not begin to run until the 45 day period for responding to the plaintiff’s demand expired. 

The insurer also moved for dismissal of the plaintiff’s claim for intentional infliction of emotional distress based on D’Ambrosio v. Pennsylvania Nat’l Mutual Ins. Co., 494 Pa. 501, 431 A.2d 966 (1981), in which the state Supreme Court held that emotional distress damages were not recoverable in a trespass claim for an insurer’s bad faith.  The court noted, however, that the Supreme Court in D’Ambrosio did not rule out the recovery of such damages in a contract claim, and the punitive damages remedy of §8371 does not preclude an insured from recovering compensatory damages in other claims.

Medical Malpractice Case Notes

by John P. Gismondi, Esq.

John Gismondi, a principal in the Pittsburgh firm of Gismondi & Associates, P.C., is Chair of the Medical Malpractice Section and is on the Board of Governors.

CAT Fund coverage does not apply to nursing home’s alleged unsanitary and poor dietary conditions. Stenton Hall Nursing v. Medical Professional Liability Catastrophe Loss Fund, (Commonwealth Court, June 27, 2023).

FACTS: A patient died as a result of salmonella poisoning that was allegedly caused by poor sanitary and/or dietary conditions at the plaintiff’s nursing home. The nursing home tendered their primary policy to the CAT Fund, but the Fund denied coverage claiming that the allegations of negligence did not arise from the furnishing of medical services. The nursing home filed suit to enforce coverage.

HOLDING: The Commonwealth Court, per President Judge Colins, agreed with the Fund saying that “furnishing medical services” means that the alleged acts “must be attributable to a medical skill associated with the allegedly poor sanitary and dietary conditions at the nursing home.

Statute of limitations is tolled during the time that patient’s surgeon reassures her. Ward v. Rice (Superior Court, June 27, 2023).

FACTS: Plaintiff suffers nerve damage following the extraction of her wisdom teeth. The surgery was done in March 1995. Over the next few months, the plaintiff visited the oral surgeon’s office several times and on each occasion she was reassured that things would get better and her pain would go away. In October 1995, the patient sought a second opinion with another doctor. In September 1997, the plaintiff filed a writ and thereafter a complaint. The defendant eventually filed a motion for summary judgment raising the statute of limitations, and the trial court granted that motion.

HOLDING: The Superior Court reversed the trial court saying that the defendant doctor’s repeated reassurances to the plaintiff that things would get better “lulled [plaintiff] into a false sense of security, which conduct constituted ‘concealment’ and, thus, tolled the statute of limitations” under the discovery rule. The court went on to say that once the plaintiff sought a second opinion, the statute was no longer tolled since, by that time, her conduct obviously manifested that she had lost confidence in her doctor and was no longer relying exclusively upon him.

Frye does not apply to expert testimony concerning the cause of plaintiff’s urologic condition. Tucker v. Community Medical Center (Superior Court, Sept. 17, 2003).

FACTS: The plaintiff husband was in the hospital for an exploratory laparotomy. During the procedure a Foley catheter was inserted with some difficulty. Following the procedure, plaintiff developed various urologic complications and sexual dysfunction. He filed suit against the medical provider, claiming that they used excessive force during the insertion of the Foley catheter. The defendant claimed that plaintiff’s urologic complications were caused by a previous asymptomatic stricture that rendered him susceptible to this type of injury. After a verdict was returned in favor of the defendant, the plaintiff appealed, asserting, among other things, that the trial court erred in not holding a Frye hearing on the reliability of the defense expert’s testimony that his pre-existing condition was the cause of plaintiff’s injury.

HOLDING: The Superior Court initially held that plaintiff waived the Frye issue, but the court then went on to explain that, even if the issue had been preserved, the trial court committed no error because the defense expert merely relied on scholarly journals, review of medical records, and examination of the patient to reach his conclusion. That is customary process of thinking, said the court, and it is certainly not the sort of “novel science” which must be involved to invoke Frye.

Frye does not apply to issue involving the prevalence of a particular lab test. MCM v. Hershey Medical Center (Superior Court, Sept. 15, 2003).

FACTS: The plaintiffs’ minor son suffered irreversible brain damage as a result of an in-born error of metabolism. The parents sued Hershey Medical Center on the ground that it failed to routinely perform a certain newborn screening test known as an MS/MS Screening. The trial court granted the defendant’s Frye motion to exclude the plaintiffs’ expert testimony on the ground that MS/MS Screening had not gained general acceptance in the medical community to permit testimony about it.

HOLDING : The Superior Court reversed, saying that the trial court had improperly framed the issue. In particular, the question was not whether the results of MS/MS Screening are generally accepted, but rather whether the use of the test itself has gained sufficient general acceptance to say that the hospital was negligent to not employ that technology. When framed in that light, the court said the case did not involve any “novel scientific evidence” because it merely related to how wide-spread the use of the test was. Thus, it was not truly a Frye matter.

Special Needs Trusts
Case Notes

by Dennis McAndrews

Dennis C. McAndrews regularly represents persons with disabilities and their families in developing special-needs trusts and in special education, guardianship, estate planning, and injury cases.


The ABCs of Uses of Special Needs Trust Monies

As most practitioners now realize, Special Needs Trusts are intended to provide for  “supplemental” needs of a disabled beneficiary beyond ordinary food, clothing, and rent payments.  In most cases, it is anticipated that these basic necessities will be provided through Social Security payments for other public programs (such as Supplemental Security Income),  and that the Special Needs Trust will provide supplemental needs to enhance the quality of life of the disabled beneficiary.
Some of the most common purchases that can be made from a Special Needs Trust include a motor vehicle (adapted if necessary to meet the needs of the disabled individual), a residence (typically titled in the name of the Trust), furniture, computer/electronic equipment, and entertainment expenses.  However, various other goods and services may be purchased from the Special Needs Trust for the disabled individual, and it can be useful to possess a checklist of some of these items.  The following list represents the “ABCs” of the common uses of proceeds of a Special Needs Trust.

•  Architectural modification to residence owned  by Trust or Beneficiary to permit greater
• Automobile/Van
•  Accounting services
•  Appliances (TV, VCR, stereo, microwave,   stove, refrigerator, washer/dryer)
•  Assistive technology
•  Attendant care
•  Biofeedback
•  Bottled water or water service
•  Bus pass/public transportation costs
•  Cable television service
•  Camera, film, recorder and tapes, development  of film
•  Case management and oversight of programs   for the beneficiary
•  Clubs and club dues (record clubs, book clubs,  health clubs, service clubs, zoo, Advocacy   Groups, museums)
•  Computer hardware, software, programs
•  Concerts
•  Conferences
•  Counseling
•  Courses or classes (academic or recreational)   including supplies
•  Court costs (e.g., to appoint a guardian)
•  Curtains, blinds, drapes and the like
•  Dental work not covered by Medicaid,
 including anesthesia
•  Dry cleaning and/or laundry services
•  Educational Programs
•  Elective surgery
•  Electronic equipment
•  Evaluations by licensed professionals
•  Fitness equipment
•  Funeral expense (prepaid)
•  Furniture, home furnishings
•  Gasoline and/or Maintenance for automobile
•  Haircuts/Salon services
•  Hobbies/Crafts
•  Holiday Decorations, parties, dinner dances,   holiday cards, reasonable modest gifts from   beneficiary for customary special occasions to   close family/friends
•  Home alarm and/or monitoring/response system
•  Home improvements, repairs and maintenance  (not covered by Medicaid), including tools to   perform home improvements, repairs and   maintenance by homeowner
•  Home Purchase
•  House cleaning/maid services
•  Insurance (automobile, home and/or
•  Internet access
•  Jazz Festival tickets
•  Job coach
•  Kitten
•  Knapsack
•  Legal Fees/Advocacy
•  Linens and towels
•  Massage therapy
•  Musical instruments (including lessons and   music)
•  Non-food grocery items (laundry soap,   bleach, fabric softener, deodorant, dish soap,   hand and body soap, personal    hygiene products, paper towels, napkins,
 tissues, toilet paper, any  household cleaning   products)
•  Over-the-counter medications (including
 vitamins and herbs, etc.)
•  Paper
•  Personal Assistance Services not covered by   Medicaid
•  Pet and pet’s supplies, veterinary services
•  Physician specialists if not covered by   Medicaid
•  Postage
•  Private counseling if not covered by Medicaid
•  Psychiatric services
•  Psychological services
•  Quiet time through library or reading club   dues or mediation training
•  Repair services (appliance, automobile,
 bicycle, household, fitness equipment)
•  Snow removal/Landscaping/Lawn Service
•  Sporting goods/equipment/uniforms/team
•  Stationary, stamps, cards, etc.
•  Storage Units
•  Taxi cab
•  Telephone service and equipment, including   cell phone, pager, etc.
•  Therapy (Physical, Occupational, Speech) not  covered by Medicaid
•  Tickets to concerts or sporting/entertainment   events (for beneficiary and an accompanying  companion)
•  Toiletries
•  Transportation (automobile, motorcycle,
 bicycle, moped, gas, bus passes)
•  Utility bills (e.g., direct TV, cable TV,
 telephone - but be cautious regarding
•  Umbrellas
•  Visits to family and friends
•  Valise
• Writing utensils
•  Xylophone or other music lessons
•  Yearbooks
•  Yuletide festivities
•  Zoo tickets